Arrhythmia - broad complex / Brady / genetic Flashcards by Eilidh Seaton

What are broad complex tachycardia / ventricular

HR >100

QRS >120

How well did you know this?

Not at all

Perfectly

If there is no clear QRS what is the Dx

VF (chaotic / no pattern)

Unusual to capture on ECG as cardiac arrest rhythm

How well did you know this?

Not at all

Perfectly

What is DDX of broad complex tachycardia

Ventricular fibrillation
Ventricular tachycardia
SVT with BBB / metabolic disturbance
WPW with anti-dromic tachy

How well did you know this?

Not at all

Perfectly

What causes irregular ventricular tachycardia (broaD)

Torsades de points

Any cause of SVT + BBB / metabolic usually AF if irregular

How well did you know this?

Not at all

Perfectly

What is VF

Cardiac arrest
No P wave or QRS
Random signals generated through ventricles

How well did you know this?

Not at all

Perfectly

What is VT

Signal from AV sets of own impulse instead of going down bundle of His
Very broad QRS

How well did you know this?

Not at all

Perfectly

What types of VT can you get

Monomorphic - usually MI

Polymorphic - torsade de points

How well did you know this?

Not at all

Perfectly

What are symptoms of ventricular tachycardia / broad complex tachy

Palpitations
CHest pain
SOB
Dizzy
Syncope if fast enough 
Low BP
Heart failure

How well did you know this?

Not at all

Perfectly

What are adverse signs suggesting immediate cardio version

Decreased consciousness
Syncope
BP <90
Clammy
Oliguria
Angina
Pulmonary oedema

How well did you know this?

Not at all

Perfectly

Who is at risk of broad complex tachycardia / ventricular

Post MI
IHD for VT
Long QT syndrome 
Cardiomyoapthy
Hypokalaemia
Hypomagneisum

How well did you know this?

Not at all

Perfectly

How do you deal with VT / broad

12 lead ECG
Cardiac monitor 
Have defibrillator close 
O2 sats
Bloods - U+E

How well did you know this?

Not at all

Perfectly

How do you differentiate SVT from VT

Hx
12 lead ECG showing broad vs narrow
Response to medication

How well did you know this?

Not at all

Perfectly

If peri-arrest what do you assume

Ventricular and Rx as this

How well did you know this?

Not at all

Perfectly

If no pulse

Cardiac arrest

How well did you know this?

Not at all

Perfectly

If patient is stable what do you do

IV access 
O2 if low sats 
Correct electrolyte 
Identify underlying rhythm
If in doubt treat as VT (most common cause)

How well did you know this?

Not at all

Perfectly

What do you do if unstable VT or uncertain

HELP FAST
DC Cardioversion if adverse signs
CPR
Correct electorlyte

How well did you know this?

Not at all

Perfectly

What do you follow up with

IV amiadarone 300mg then 24 hour infusion 900
Lidocaine if fails
ICD / EPS if this fails
Can have maintenance treatment of BB or amiadarone

How well did you know this?

Not at all

Perfectly

When do you caution with lidocaine

Severe left ventricular impairment

How well did you know this?

Not at all

Perfectly

What do you never use in ventricular tachy

Verapamil

How well did you know this?

Not at all

Perfectly

What do you do after correct

Establish cause
Maintenance AA - BB / amiadarone
ICD / surgery may help esp if LV functional impairment

How well did you know this?

Not at all

Perfectly

How do you Rx VF

Cardiac arrest
DC cardio version
AA
ICD

How well did you know this?

Not at all

Perfectly

What is Tornado de point

Form of polymorphic VT associated with long QT

Have long QT syndrome then ectopic hits to generate abnormality

How well did you know this?

Not at all

Perfectly

What is it associated with / what causes

Long QT syndrome 
Ischaemia - may see STEMI
Drugs  
- Amiadarone 
- Sotolol 
- Anti-psychotics
- TCA 
- Macrolide Ax - mycin
Electrolyte 
- Hypocalcaemia
- Hypomagnesium
- Hypokalaemia
SAH
Hypothermia
Myocarditis

How well did you know this?

Not at all

Perfectly

What is seen on ECG

VT with polymorphic QRS so height changes

How well did you know this?

Not at all

Perfectly

How do you Rx

Correct underlying cause IV Mg sulphate Stop any drugs that prolong QT Long term - BB (not sotolol) - Pacemaker

What can it progress to

Usually revert back but can translate to VT and cardiac arrest Cardiac arrest so have defibrillator ready

What is ventricular ectopic

Random beat originating out with atria

When is it common

Post MI / IHD / HF | Can occur in healthy

How does it present

``` Asymptomatic Palpitation Thumbing heart Heart missing a peace Irregular pulse if frequent ```

How does it present on ECG

Broad QRS with random extra

How do you investigate

Blood for anaemia, thyroid, electrolyte

How do you Dx

Reassure | If post MI can lead to more serious arrhythmia

What types of bradycardia

``` Sinus Heart block AF with slow ventricular response Flutter + high degree block Junctional ```

When is Brady physiological

Athletes | Sleep

What are cardiac causes of bradycardia

``` AV block Sinus node disease Degeneration of conduction if Hx of BBB Post MI IHD Sick sinus Ablation Valvular disease IE Myocarditis Cardiomyopathy ```

What do you do if IE

Daily ECG

What drugs cause Brady

BB Rate limiting CCB - Verapamil / dilitiazem Digoxin Amiodarone

What are non-cardiac causes

``` Vasovagal = very common Hypothyroid Hypoadrenal Hyperkalemia Hypoxia Hypothrmia Increased ICP / Cushing ```

What are the symptoms of Brady

``` Asymptomatic Chest pain SOB Fatigue Nausea Dizzy ```

What suggests harm-dynamic compromise and the need for Rx as per-arrest with IV atropine

``` Shock Hypotension Syncope MI Ischaemia HF ```

What causes hypotension

Brady NOT hypovolemia so no fluid bolus

How do you investigate Brady

``` ABCDE O2 if hypoxic BP IV access - Bloods - U+E - Digoxin level Reverse and treat electrolyte abnormality 12 lead ECG if come in with bradycardia Cardiac monitor Look at drugs ```

What do you do if think you will need

Call anaestheist

If adverse signs what do you give

IV atropine | 500mcg up to 3mg

What do you do if not improving

Other inotropes Adrenaline Transcutaneous pacing

What do you do if stable

O2 IV access Treat cause Observation

If Brady improves but still at risk of astyole

Long term pacing

Who is at risk of astyoel

Recent astyole AV block type II Complete heart block Ventricular pause >3s

What is important as well as ECG

Clinical signs | If look unwell= WORRY

What do you do if Cushing's

SENIOR ADVICE

What causes AV heart block

``` AV node issue IHD - inferior MI RCA BB Amiodarone Fibrosis ```

What is 1st degree block

Electrical impulses slow All reach ventricle Long PR >0.2s

How does it present and Rx

No symptoms | No Rx

What is 2nd degree MObitzz type 1

PR delayed until beat fails to reach ventricle (no QRS) | May be dizzy

Wha is 2nd degree type II

PR constant but P wave not always followed by QRS | 2:! or 3:!

What do you do for type II

Pacemaker | Commonly progresses to type 3

What is type 3

No electrical impulses reach ventricle Generate own escape beats Not coordinated with atrial

How do you differentiate type 3 from VF

Atrial faster than ventricle in AV block

What is BBB

Impulses slow or blocked as they travel through conducting tissue in one of two ventricles - either R or L

How does heart block present

``` SOB Syncope HF Bradycardia Wide pulse pressure JVP shows cannon waves ```

How do you Rx

Same as Brady above Observe if stable IV atropine Pacing for type 2 and type 3

When is pacing CI

Infection

What causes sick sinus syndrome

Sinus node fibrosis | Common in elderly

How does it present

``` Sinus Brady AF or atrial tachy Syncope Dizzy Palpitations SOB Cardiac arrest ```

How do you Rx

PACEMAKER | Anti-coagulant if AF

What causes long QT

``` Congenital / genetic - Issue with KCN gene Drugs Hypo K, Mg, Ca MI Myocarditis Hypothermia SAH ```

What drugs

``` Amiadarone Sotalol TCA SSRI esp citalopram Haloperidol Macrolide - erythromycin Methadone ```

What is long QT

Delayed depolarisation of ventricle

How does long QT present

``` Ventricular tachy - paroxysmal polymorphic Torsade de points Leads to - Syncope - Seizure - Sudden death ```

What exacerbates

Emotion Exercise Drugs

How do you Rx

Avoid drugs which prolonged QT BB Nicroandil ICD if high risk e.g. QT >500 or previous cardiac arrest

What BB do you avoid

Sotalol

What is Brugada

AD SCNA5 Na channelopathy Causes sudden death

What is seen on ECG

ST elevation -ve T wave V1-V3 Partial RBBB

How do you cause more apparent ECG

Administer flecainide

What do you do if Dx

Implantable cardiac device | Screen family

Arrhythmia - broad complex / Brady / genetic Flashcards

(76 cards)