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CVD > 9. b. Arrhythmias > Flashcards

9. b. Arrhythmias Flashcards

1
Q

Name 2 bradyarrhythmias

A

Sick sinus syndrome: SA node malfunction

Heart block: AV node malfunction

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2
Q

How can sick sinus syndrome be seen on an ECG?

A

Missed beats

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3
Q

How can heart block be seen on an ECG?

A

PR interval bigger than 1 box

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4
Q

Which ECG leads is the P wave best seen in?

A

2, 3, AVF, V1

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5
Q

How should heart block be managed?

A

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

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6
Q

What does paroxysmal mean?

A

Short burst

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7
Q

What does a sustained tachycardia mean?

A

Lasts longer than 30 seconds

Requires intervention to stop

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8
Q

What does a non-sustained tachycardia mean?

A

Less than 30 seconds

Will self-terminate

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9
Q

What does a recurrent tachycardia mean?

A

Occurs periodically

More time non-tachycardic than tachycardic

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10
Q

What is atrial fibrillation?

A

Atrium is beating 400-600 BPM

Irregularly irregular conduction to AV node

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11
Q

How can atrial fibrillation be seen on an ECG?

A

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

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12
Q

What are the cornerstones of atrial fib management?

A 
Avoid a stroke
Control symptoms (rate and rhythm
Reduce CV risks
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13
Q

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

A

CHADS2VASc

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14
Q

What drugs are given in non-valvular atrial fib?

A

Warfarin or DOACs

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15
Q

What is valvular atrial fib?

A

Atrial fib with mitral stenosis or an artificial valve

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16
Q

What drug is given in valvular atrial fib?

A

Warfarin to avoid thromboembolism from valves

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17
Q

What drugs are given for rate control in atrial fib?

A

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

18
Q

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

A

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

19
Q

How is rhythm control carried out in atrial fib?

A

Chemical or synchronised electrical cardioversion

20
Q

What are the risk factors for atrial fib?

A 
Hypertension, heart failure, coronary artery disease
Diabetes, hyperthyroidism
Sleep apnoea
Electrolyte imbalances
High alcohol or caffeine intake
21
Q

What is atrial flutter?

A

Atrial rate 250-320 BPM

22
Q

How can atrial flutter be seen on ECG?

A

Regular ‘saw tooth’ pattern

Narrow QRS

23
Q

Where does supra-ventricular tachycardia originate?

A

AV node

24
Q

How can supra-ventricular tachycardia be seen on ECG?

A

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

25
Q

How is supra-ventricular tachycardia managed?

A

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

26
Q

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

A

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

27
Q

How is ventricular tachycardia seen on ECG?

A

Lots of broad QRS

Rapid HR

28
Q

What is ventricular tachycardia?

A

Caused by a re-entry pathway in the ventricles

29
Q

What are the causes of ventricular tachycardia?

A

Ischaemic heart disease

Cardiomyopathy

30
Q

How is stable ventricular tachycardia managed?

A

Antiarrhythmic
Synchronised electrical cardioversion
Treat underlying cause and monitor

31
Q

How is unstable ventricular tachycardia managed?

A

synchronised electrical cardioversion and antiarrhythmic

32
Q

How is pulseless unstable ventricular tachycardia managed?

A

CPR
Unsynchronised defib
Adrenaline and amiodarone

33
Q

How is ventricular tachycardia managed longterm?

A

Implantable defib

34
Q

What is polymorphic ventricular tachycardia/ torsade de pointes?

A

QRS changes shape and axis

35
Q

what condition causes polymorphic ventricular tachycardia?

A

MI

36
Q

What condition causes torsade de pointes?

A

Long QT syndrome

37
Q

What is ventricular fibrillation?

A

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

38
Q

What are the causes of ventricular fibrillation?

A

MI
PE
Drowning
Electric shock

39
Q

How is ventricular fibrillation treated?

A

CPR
Defib
Adrenaline
Amiodarone

40
Q

What is long QT syndrome?

A

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

CVD (22 decks)

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