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NW Studies > Arrhythmia > Flashcards

Arrhythmia Flashcards

1
Q

Main Arrhythmia Presentations[3 Arrhythmia Types + 1 resulting Presentation/Consequence each]

A

Tachyarrhythmia - PalpitationsBradyarrhythmia - Pre-/SyncopeCombination - both

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2
Q

History of Palpitations[Cardinal features; 5 Questions to ask; give +2 examples for 4]

A

Character (forceful/missed beat/how rapid)Tap Out Rhythm (regular/irregular)Onset/OffsetPrecipitant (caffeine, stress, quiet room)Associated Features (chest pain, dyspnea, sync/presyncope)

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3
Q

What could the pt mean with palpitation [ X beat; 4]

A

Fast Heart BeatMissed BeatIrregular BeatAware of Forceful Beat

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4
Q

Palpitations: What Investigations?[ 3 ]

A
  • ECG (holter monitor)- Echocardiogram (structural heart heart disease)- Special: Electrophysiology study
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5
Q

Holter vs. Event vs. Loop Recorder[ 1 main distinguishing feature]

A

Holter: 24hrs; records everythingEvent: pt triggered; 20min memoryLoop: 3 yrs; surgery + small scar

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6
Q

Investigation for Cardiac Ischemia [2]

A
  • Stress Test- Coronary Angiography
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7
Q

Premature Ventricular/Atrial Complexes[2: general prognosis; advice ]

A
  • usually benign- cut down on caffeine
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8
Q

Atrial Fibrillation[ important why? Symptoms [3] + when + what causes symptoms?]

A
  • Symptoms due to rapid heart rate- Symptoms: palpitations, SOB, Angina, esp. on exertion- ↑Risk of Stroke / PE
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9
Q

AF Management[ 4 Issues]

A
  1. Rule out Precipitant, e.g. hypothyroid, infection2. Cause? e.g. AF common in cardiomyopathy3. Decision: Rate vs. Rhythm4. Evaluate Stroke Risk (vs. Bleed; second Decision)
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10
Q

AF Decision: Rate vs. Rhythm[purpose/idea of each; how to achieve - 3 each; +pro/con]

A

Rhythm:- Maintain Rhythm- Antiarrhythmic agents:Sotalol, Flecainide, Amiodarone(+/- electrical cardioversion; catheter ablation)- however can cause other arrhythmia - e.g. VTRate Control:- safer- Slow conduction at AV Node- Beta Blockers, Ca Channel Blockers, Digoxin

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11
Q

AF Decision: Stroke Risk vs. Bleeding Risk[2 groups; 5 drugs total]

A

Anticoagulants - Warfarin- New: Dabigatran, Rivaroxaban, Apixabanvs.Aspirin (note antiplatelet)

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12
Q

AF: Catheter Ablation- When [in what situation]- Aim [+ concept behind]- Target specific

A
  • When: persistent symptoms despite therapy- Aim: maintain sinus rhythm by stopping AF propagating sites- AF sites: around pulmonary veins- 70-80% success
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13
Q

SVT (1)- Describe ECG [3]- Statistics: [%] due to … [pathway/mechanism]; most common [XXX tachycardia]- Also …[a type of SVT]

A
  • ECG: regular, narrow complex tachycardia- 90% due to re-entrant circuits- most common AV Nodal re-entry tachycardia- also Wolff-Parkinson White SyndromeRe-entry Note: when propagating impulse fails to die out after normal activation, and persists to re-excite the heart - can also occur in AF/Flutter, VT after MI, or VF
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14
Q

SVT (2)- [Invasive Treatment] targets [ anatomical location/structure] + why [simple]- [%] success rate

A
  • Catheter Ablation targets: AV node, because it’s normally involved in SVT - 95% success rate
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15
Q

SVT (3) - Acute Treatment- Non-pharmacological [1]- Pharmacological [2]

A
  • Vagal Maneuver- IV Adenosine- IV Verapamil in 1mg increments
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16
Q

SVT Adenosine for Acute Treatment- Before administration [do what?]- How administered?- Effect [why does it work; effective?]

A
  • Before: warn pt of flushing/feeling terrible for a few seconds- 6-12 mg IV stat (followed by saline flush)- transient AV block; very effective
17
Q

Wolff-Parkinson White Patter- pattern is indicative [what causes this pattern]- Effect of this pathology [as a result; what happens - ECG finding [describe + name]

A
  • indicates large macro re-entrant pathway bypassing AV node- excites the ventricle earlier than normal- ECG: slurred upstroke of QRS ==> Delta Wave
18
Q

Broad Complex Tachycardia is…

A

Ventricular Tachycardia until proven otherwise

19
Q

VTGenerally, requires … [action]A) Sustained VT is a [implication]B) If Hemodynamically Unstable [do what; action]C) If Sustained + Hemodynamically unstable [action; 2 / kind of 3]

A

Requires continuous Cardiac monitoringA) sustained VT = Cardiac EmergencyB) requires immediate DC ReversionC) Sustained + Hemo-Unstable –> Amiodarone (pharmacological reversion) + DC shock under sedation

20
Q

VT - Causes [2]For each cause, how would you confirm it? [3 for (a), 1 for (b)]

A

(a) Cardiac Ischemia- possibly as complication of MI- ECG, Troponin, Angiogram(b) Significant underlying Cardiac Disease- e.g. Cardiomyopathy- Echocardiography

21
Q

PalpitationsWhen to worry [8 of which 3 are situational]

A
  • PMHx of Cardiac Disease- FmHx of Sudden Cardiac Death- Evidence of Cardiac Disease (on baselines tests; e.g. echocardiography)- Severe Symptoms- Cardiac Arrhythmia documented (at time of symptoms)- High Risk Work environment (e.g. heavy vehicle)- High Level Sporting Activities- Before/During Pregnancy
22
Q

Syncope ECG Abnormalitites- 2 Types of Disease + signs of ECG- Rarely… [2 diseases/ECG patterns

A

A) Sinus Node Disease: Sinus Bradycardia, pausesB) AV Conduction Block: 1st/2nd/3rd degree Rare: WPW pattern, Long QT Interval

23
Q

AV Conduction Block (1)1st Degree[2; 1 abnormal ECG feature]

A

PR Interval > 0.2 secondsEvery p wave followed by QRS complex

24
Q

AV Conduction Block (2)2nd Degree: Mobitz Type 1[3; ECG changes]

A

(Wenckebach Block)1) Progressively ↑PR Interval + ↓RR Interval2) eventually P wave is blocked3) After blocked beat: ↓PR Interval(note: still see P wave, but no QRS/beat pause, because no conduction)

25
Q

AV Conduction Block (3)2nd Degree: Mobitz Type 2[2; ECG]

A
  • intermittently blocked P waves- constant PR interval (on conducted beats) (note: still see P wave; but no QRS/beats; because no conduction)
26
Q

AV Conduction Block (4)2nd Degree: High Grade AV Block[2; ECG]

A
  • 3:1 conduction ratio or more- constant PR interval of conducted beats(note: it takes 3x p waves to cause a QRS/beat)
27
Q

AV Conduction Block (5)3rd Degree AV block[2, ECG]

A
  • Dissociation between Atrial and Ventricular activity- Atrial Rate > Ventricular Rate(Ventricular rate is of junctional or ventricular origin)(note: compared to others, the QRSs/beats are regular)
28
Q

Indications for PPM

A
  • Sinus Node Dysfunction (symptomatic sinus bradycardia; sinus pauses >2s day or 2.5s night)- 2nd Degree AV Block: IF Symptomatic - 3rd Degree AV Block IF Symptomatic or Intermittent
29
Q

Combined Tachy/Bradyarrhythmias- describe [one liner + elaborate]- Mx? [2; pharma + intervention]- Dx? [1 + see Mx]

A
  • Tachy-brady syndrome- Sinus Brady/Pauses + Episodes of AF w/ rapid HR- Difficult Mx w/o Pacemaker (treating tachy, worsens brady)- Dx with Holter Monitor (avoid AV Node Blockers until PM)(e.g. IIIII ____ IIIII ____ IIIIII, when normal is I I I I)

NW Studies (3 decks)

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