9. b. Arrhythmias

Question 1

Name 2 bradyarrhythmias

Answer 1

Sick sinus syndrome: SA node malfunction

Heart block: AV node malfunction

Question 2

How can sick sinus syndrome be seen on an ECG?

Answer 2

Missed beats

Question 3

How can heart block be seen on an ECG?

Answer 3

PR interval bigger than 1 box

Question 4

Which ECG leads is the P wave best seen in?

Answer 4

2, 3, AVF, V1

Question 5

How should heart block be managed?

Answer 5

Treat the underlying conditions
Discontinue drugs that reduce heart rate
Atropine or dopamine in unstable patients
Pacemaker in complete block

Question 6

What does paroxysmal mean?

Answer 6

Short burst

Question 7

What does a sustained tachycardia mean?

Answer 7

Lasts longer than 30 seconds

Requires intervention to stop

Question 8

What does a non-sustained tachycardia mean?

Answer 8

Less than 30 seconds

Will self-terminate

Question 9

What does a recurrent tachycardia mean?

Answer 9

Occurs periodically

More time non-tachycardic than tachycardic

Question 10

What is atrial fibrillation?

Answer 10

Atrium is beating 400-600 BPM

Irregularly irregular conduction to AV node

Question 11

How can atrial fibrillation be seen on an ECG?

Answer 11

No distinct p waves
QRS usually narrow
May have fibrillatory waves: baseline is jagged

Question 12

What are the cornerstones of atrial fib management?

Answer 12

Avoid a stroke
Control symptoms (rate and rhythm
Reduce CV risks

Question 13

What score is used to stratify the risk of stroke in non-valvular atrial fib?

Answer 13

CHADS2VASc

Question 14

What drugs are given in non-valvular atrial fib?

Answer 14

Warfarin or DOACs

Question 15

What is valvular atrial fib?

Answer 15

Atrial fib with mitral stenosis or an artificial valve

Question 16

What drug is given in valvular atrial fib?

Answer 16

Warfarin to avoid thromboembolism from valves

Question 17

What drugs are given for rate control in atrial fib?

Answer 17

B-blockers, Ca channel blockers
Digoxin
Amiodarone if all else fails

Question 18

When is rhythm control introduced into the management of atrial fib?

Answer 18

Only if the patient is symptomatic and not fixed by rate control

Question 19

How is rhythm control carried out in atrial fib?

Answer 19

Chemical or synchronised electrical cardioversion

Question 20

What are the risk factors for atrial fib?

Answer 20

Hypertension, heart failure, coronary artery disease
Diabetes, hyperthyroidism
Sleep apnoea
Electrolyte imbalances
High alcohol or caffeine intake

Question 21

What is atrial flutter?

Answer 21

Atrial rate 250-320 BPM

Question 22

How can atrial flutter be seen on ECG?

Answer 22

Regular ‘saw tooth’ pattern

Narrow QRS

Question 23

Where does supra-ventricular tachycardia originate?

Answer 23

AV node

Question 24

How can supra-ventricular tachycardia be seen on ECG?

Answer 24

RAte 150-230 BPM
Narrow QRS
Absent P waves
ST may be depressed

Question 25

How is supra-ventricular tachycardia managed?

Answer 25

Vagal manoeuvres to increase parasympathetic tone Adenosine to block AV conduction Electrical cardioversion if unstable

Question 26

How can Wolff Parkinson White syndrome be seen on an ECG?

Answer 26

Short PR Delta wave (notch on the upstroke of QRS) Broad QRS

Question 27

How is ventricular tachycardia seen on ECG?

Answer 27

Lots of broad QRS | Rapid HR

Question 28

What is ventricular tachycardia?

Answer 28

Caused by a re-entry pathway in the ventricles

Question 29

What are the causes of ventricular tachycardia?

Answer 29

Ischaemic heart disease | Cardiomyopathy

Question 30

How is stable ventricular tachycardia managed?

Answer 30

Antiarrhythmic Synchronised electrical cardioversion Treat underlying cause and monitor

Question 31

How is unstable ventricular tachycardia managed?

Answer 31

synchronised electrical cardioversion and antiarrhythmic

Question 32

How is pulseless unstable ventricular tachycardia managed?

Answer 32

CPR Unsynchronised defib Adrenaline and amiodarone

Question 33

How is ventricular tachycardia managed longterm?

Answer 33

Implantable defib

Question 34

What is polymorphic ventricular tachycardia/ torsade de pointes?

Answer 34

QRS changes shape and axis

Question 35

what condition causes polymorphic ventricular tachycardia?

Answer 35

MI

Question 36

What condition causes torsade de pointes?

Answer 36

Long QT syndrome

Question 37

What is ventricular fibrillation?

Answer 37

Rapid irregular ventricular contraction resulting in reduced CO Fatal unless immediately acted upon

Question 38

What are the causes of ventricular fibrillation?

Answer 38

MI PE Drowning Electric shock

Question 39

How is ventricular fibrillation treated?

Answer 39

CPR Defib Adrenaline Amiodarone

Question 40

What is long QT syndrome?

Answer 40

Abnormality of Na and/or K channels Susceptible to Torsade de pointes Can be drug induced