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Cardiovascular RT > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

where is the origin of a supraventricular arrhythmias?

A

above the ventricle

ie SA, atria, AV, HIS

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2
Q

where is the origin of a ventricular arrhythmia?

A

ventricle

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3
Q

what should be the only point of electrical contact between the atria and the ventricles?

A

AV node

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4
Q

what are ectopic beats?

A

beats or rhythms that originate in places other than the SA node

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5
Q

what are 3 common supraventricular tachycardias?

supraventricular arrhythmias

A

AF
Atrial flutter
ectopic atrial tachycardia

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6
Q

what are 2 common supraventricular bradycardia arrhythmias?

A

sinus bradycardia

sinus pauses

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7
Q

what are 3 common AV node arrhythmias?

A

AVN re-entry
Accessory pathway
AV block

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8
Q

what are 4 common ventricular arrhythmias?

A

premature ventricular complex (PVC)
ventricular tachycardia
ventricular fibrillation
asystole

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9
Q

what causes premature ventricular complexes?

A

ectopic beats originating from the ventricles

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10
Q

how can an accessory pathway arrhythmia be acquired?

A

MI

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11
Q

how can sleep apnoea cause arrhythmias?

A

because patients get hypoxic at night- metabolic cause of arrhythmia

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12
Q

what type of arrhythmia occurs in Wolf Parkinson White syndrome (WPW)?

A

re-entry:

accessory pathway tachycardia

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13
Q

what does hypothermia do to the pacemaker potential slope?

A

decreases slope- negative chronotropic effect

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14
Q

what does hyperthermia do to the pacemaker potential slope?

A

increases slope- positive chronotropic effect

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15
Q

what does hypoxia do to the pacemaker potential slope?

A

increases slope- positive chronotropic effect

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16
Q

what does hypercapnia do to the pacemaker potential slope?

A

increases slope- positive chronotropic effect

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17
Q

why can ischaemia or necrosis increase ectopics?

A

because local areas of ischaemia or necrosis increases automaticity of neighbouring cells

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18
Q

what does hypokalaemia do to the pacemaker potential slope, automaticity and length of repolarisation?

A 
increase pacemaker potential slope
increases automaticity (therefore increases ectopics)
prolongs repolarisation
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19
Q

what does hyperkalaemia do to the pacemaker potential slope and AV conduction?

A

decreases pacemaker potential slope

slows AV node conduction

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20
Q

what is an afterdepolarisation?

A

a small depolarisation after the repolarisation phase of an AP, if this is of sufficient magnistude this will reach threshhold and lead to a full depolarisation- triggered activity

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21
Q

what are the 5 main symptoms of an arrhythmia?

A 
palpitations
SOB
dizziness
syncope
sudden cardiac death
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22
Q

what are the 7 investigations used for a suspected arrhythmias?

A 
12 lead ECG
CXR
echocardiogram
stress ECG
24 hour ECG Holter monitoring
event recorder
Electrophysiological study
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23
Q

what type of heart disease do echocardiograms show?

A

structural heart disease

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24
Q

what is a stress ECG?

A

heart is provoked in a controlled way, ischamia or arrhythmias may only be present when the cardiac demand is higher

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25
Q

what is an event recorder?

A

a monitor which only turns the recorder on if it detects a change- if the patient feels symptoms it can manually be switched on

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26
Q

what is an electrophysiological stufy?

A

an invasive investigation which deliberately induces a clinical arrhythmia to study mechanism and map the pathway
opportunity to treat the arrhythmias by radiofrequency ablation

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27
Q

what is pre-excitation?

A

accessory pathway from atria to ventricles for AP to flow

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28
Q

what is the function of a 24 hour Holter ECG?

A

assesses for paroxysmal arrhythmias

heart rhythm is rarely captured though

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29
Q

what vein is the catheter for an electrophysiological study usually put through?

A

femoral vein

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30
Q

if an atrial ectopic beat is asymptomatic how do you treat?

A

no treatment

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31
Q

if an atrial ectopic beat has palpitations how do you treat?

A 
beta blockers
stimulant avoidance (caffeine, cigarettes)
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32
Q

what type of STEMI is most likely to cause sinus bradycardia?

A

inferior MI

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33
Q

how do you treat acute sinus bradycardia?

A

atropine

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34
Q

how do you treat sinus bradycardia if it causes haemodynamic compromise?

A

pacing

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35
Q

compare SVT to VT on ECG?

A

SVT- narrow complex tachycardia

VT- broad complex tachycardia

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36
Q

why are SVTs generally more tolerated than VTs?

A

because there are narrow complexes it means the heart is still pumping in a meaningful way

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37
Q

what is the purpose of vagal manoeuvers?

A

to stop supra-ventricular tachycardias

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38
Q

what is the vagal manouevre for infants?

A

ice water to face

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39
Q

what are the vagal manouevres for children?

A

blow through straw (valsalva manoeuvre)

carotid sinus massage

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40
Q

what are the vagal manouevres for adults?

A 
carotid sinus massage
breath holding
coughing
NG placement
gagreflex
anal sweep
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41
Q

what 3 things may supraventricular tachycardias be due to?

A

AV nodal re-entrant tachycardia
accessory pathway tachycardia (ie WFW)
ectopic atrial tachycardia

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42
Q

what are the 2 types of re-entry tachycardia?

A

AV nodal re-entry

accessory pathway

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43
Q

where is the accessory pathway circuit in an AV nodal re-entry arrhythmia?

A

AV node itself

44
Q

what is the acute management of a SVT?

A

vagal maneuvres
IV adenosine
IV verapamil

45
Q

what is the chronic management of a SVT?

A 
avoid stimulants
radiofreq ablation
antiarrhythmic drugs (class II or IV)
46
Q

what is radioablation of an arrhythmia?

A

selective cautery of cardiac tissue to prevent tachycardia, targetting either an automatic focus or part of a re-entry circuit

47
Q

what specific valve disease/surgery is most likely to disrupt the AV node?

A

aortic valve

eg calcification or surgery

48
Q

what is 1st degree AV node block?

A

PR interval longer than 0.2s

49
Q

what is the treatment of 1st degree AV node block?

A

none but long term follow up recommended

50
Q

what is 2nd degree AV node block- Mobitz 1?

A

progressive lengthening of the PR interval, eventually resulting in a dropped beat
(vagal in origin)

51
Q

what is 2nd degree AV node block- Mobitz 2?

A

intermittent dropped beats without lengthening, usually 2:1 or 3:1

52
Q

which mobitz type is more indicative of a pathological cause?

A

mobitz type 2

53
Q

what is the interventional indication for 2nd degree AV block mobitz type 2?

A

permanent pacemaker indicated (ventricular pacing)

54
Q

what is 3rd degree AV block?

A

no APs from atria get through AV node
(full block)
ventricles and atria contract with no correlation

55
Q

in full heart block, what maintains ventricular rhythm? (and so maintains cardiac output)

A

escape rhythm

ie starts from somewhere else, not in sinus rhythm

56
Q

what is the interventional indication for 3rd degree AV block?

A

pacemaker

57
Q

describe the QRS complexes in 3rd degree heart block?

A

very broad

58
Q

what are the 2 acute pacing options?

A

transcutaneous pacer

transvenous pacer

59
Q

what are the 2 chamber options of a pacemaker?

A 
single chamber (RA or RV)
dual chamber (RA and RV)
60
Q

what are single RA chamber pacemakers (atrial pacemakers) used for?

A

isolated SA disease with normal AV node

61
Q

what are single VR chamber pacemakers (ventricular pacemakers) used for?

A

AF with slow ventricular rate

62
Q

what is the dual chamber pacemaker used for?

A

AVN disease

63
Q

what is a bad diagnostic sign when investigating a premature ventricular ectopic?

A

if worse on exercise

64
Q

what drug treatment can be used for premature ventricular ectopics?

A

B blockers

65
Q

what is ventricular fibrillation?

A

chaotic ventricular electrical activity which causes the heart to lose the ability to function as a pump

66
Q

what is the acute treatment of VT with unstable haemodnamics?

A

DC cardioversion

67
Q

what is the acute treatment of VT with stable haemodynamics?

A

pharmacological cardioversion with anti-arrhythmic drugs

68
Q

what is the long term treatment for life threatening VT?

A

implantable cardiovertor defibrillator

69
Q

what type of pulse is typical of AF?

A

irregularly irregular pulse

70
Q

what are the 3 types of AF patterns?

A

paroxysmal
persistent
permanent (chronic)

71
Q

which pattern of AF is most associated with heart disease?

A

permanent AF

72
Q

why can pseudonormalisation occur with AF?

A

because the AF is so fast it looks like normal rhythm

73
Q

what is paroxysmal AF?

A

occur in (often recurrent) sudden attacks that last less than 48 hours

74
Q

what is persistent AF?

A

an episode of AF lasting greater than 48 hours, unlikely to spontaneously revert to NSR but can be cardioverted back

75
Q

what is permanent AF?

A

AF which is unable to be restored to NSR by pharmacological or non pharmacological methods

76
Q

what is lone AF?

idiopathic AF

A

AF which occurs in the absence of any heart disease and no evidence of dysfunction
(a diagnosis of exclusion)

77
Q

what are the 7 main symptoms of AF?

A 
palpitations
pre-syncope (dizziness)
syncope
chest pain
dyspnoea
sweatiness
fatigue
78
Q

what are the 2 most common mechanisms of AF?

A

multiple wavelets of re-entry

ectopic focus around pulmonary veins

79
Q

what are 3 ways of reverting AF back to NSR?

A

spontaneous
pharmacological cardioversion (anti-arrhythmic drugs)
electrical cardioversion

80
Q

how do you recognise AF on an ECG?

ie what extra or missing waves are there

A

absence of P waves

presence of f waves

81
Q

what does pre-excitation of the ventricles do the QRS complex?

A

broadens it

82
Q

what are the 2 management options for controlling AF?

A

rhythm control

rate control

83
Q

what is the purpose of rhythm control management?

A

to maintain sinus rhythm

84
Q

what is the purpose of rate control management?

A

accept AF but control ventricular rate

85
Q

what do you use in high risk AF to prevent thromboembolism?

A

anti-coagulation

warfarin

86
Q

what are 3 rate controlling anti-arrhytmic drugs?

A

digoxin
beta blockers
calcium antagonists (verapamil, diltiazem)

87
Q

what procedures can be done to restore AF to NSR?

A

direct current cardioversion
catheter ablation of atrial focus/pulmonary veins
surgery

88
Q

what are class 1 anti-arrhythmic drugs?

A

Na+ channel inhibitors

89
Q

what are class 1 anti-arrhythmic drugs used for?

A

rhythm contol

90
Q

what are class 2 anti-arrhythmic drugs?

A

b-blockers

91
Q

what are class 2 anti-arrhythmic drugs used for?

A

rate control

92
Q

what are class 3 anti-arrhythmic drugs used for?

A

K+ chanel inhibitors

93
Q

what are class 3 anti-arrhythmic drugs used for?

A

rhythm control

94
Q

what are class 4 anti-arrhythmic drugs?

A

Calicium inhibitiors

95
Q

what are class 4 anti-arrhythmic drugs used for?

A

rate conrol

96
Q

what type of drugs are flecainide and propafenone?

A 
class 1 anti-arrhythmic drugs
Na+ channel inhibitors
(rhythm controllers)
97
Q

what type of drugs are amiodarone and sotalol?

A 
class 3 anti-arrhythmic drugs
K+ channel inhibitors
(rhythm controllers)
98
Q

how do you recognise torsades de pointes on an ECG?

A 
heart rate of 200-250bpm
irregular rhythm
long QT interval
wide QRS
continously changing QRS morphology
99
Q

what are the 3 mechanisms leading to torsades de pointes?

A 
hypokalemia
drug induced- prolongation of the AP duration
renal impairment (causing increased drug levels)
100
Q

what are the indications for anti-coagulation in AF?

A
  1. valvular disease
  2. age >75
  3. hypertension
  4. heart failure
  5. prev stroke/thromboembolism
  6. diabetes
101
Q

what is the role of radiofrequence ablation in AF?

A

either to maintain SR by ablating AF focus
or
for rate control by ablation of AVN

102
Q

in AF where are the ectopic foci usually found?

A

in muscle sleeves in the ostia of the pulmonary veins

103
Q

what is atrial flutter?

A

rapid and regular form of atrial tachycardia (AV only conducts every 2/3 impulse so ventricle rhythm can appear more normal)

104
Q

in atrial flutter what replaces the p wave?

A

saw tooth F wave

105
Q

what is the mechanism behind atrial flutter?

A

macro-reentry

106
Q

what is the treatment option with the best success in atrial flutter?

A

radiofrequency ablation

Cardiovascular RT (12 decks)

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