Arrhythmia's Flashcards
(35 cards)
How does electrical impulse spread?
From SA node, through AV node, down bundle of His then purkinje fibres
P wave is what?
Atreial depolarisation
PR inteval is what?
The time from atrial depolarisation until the ventricular depolarisation.
WHat is QRS nad T wavses?
QRS is ventricular depolarisation and T is ventricular repolarisation
What is sweep speed (paper speed)
25mm/sec
4 large squares means what heart rate?
75bpm, and 5 large squares means 60bpm, because 2.5cm/second, 1 beat/2.5cm (5 large squares) = 60pbm
What are ectopic beats?
They are premature depolarisations, can be of the atrium of the ventricles, cause an irregular heart beat.
What is AF?
When the atria are chaotically depolarising like jelly, and only some signals get through to the ventricles (thank fully), but varies, can be v fast.
What do you see on ecg AF?
Irregular narrow QRS complex, no p wave.
AF clues and confirmation
Irregularly irregular, confirmed with ECG.
AF symptoms
palpatations, dysponea, chest pain, fatigue
Hoever, can be asymptomatic or present with embolus.
DO you trust ECG machine diagnoses?
No, always double check the reading yourself
WHat investigations ?
12 lead ECG (documented) Blood tests (eg thyroid - missed unless looked for) Echocardiogram (to see movements, help determine risk and if there are any underlying causes)
Primary care do what? What drugs?
Start them on Rate control:
eg beta blocker/calcium channel blocker eg veraprimil, digoxin
Or Rhythm control in more spontaneous in and out of af - eg class Ic or class III drugs. If unable to control then will be cardioverted (with electricity/drugs eg flecainide)
WHat is cardioverson and when use?
It is reset of the heart to normal rhythm, cna be using electricity of drugs. Used mainly when the heart is unable to be controlled by other drugs.
When Pacemaker and ablation?
When (esp in older patients), they get a peranent pace maker added and the SA node burnt out so wholly reliant on the pacemaker.
What is AF a risk factor for? How do we measure the amount of risk?
Stroke! Measure risk using CHADS2 score (Congestive heart failure, Hypertension, Age ( > 65 = 1 point, > 75 = 2 points), Diabetes, previous Stroke/transient ischemic attack (2 points), so consider anticoagulation eg warfrin or ….aban eg apixaban
What is Supraventricular Tachycardia?
A VV fast heart rate, coming from an issue in ecectrical short circuiting between the Atria and the Ventricles, meaning the atria and ventricles will effectivly depolarise at the same time, v narrow QRS complex.
What is given if patient presents to A and E with SVT?
Well firstly, most patients don’e end up in A and E with SVT as it can be benign and be managed by patients without medications with Vagal manoeuvres.
If in A and E usually getting palp, and feeling dizzy and dyspnoea, adenosine is usually v good drug.
What treatment svt?
Adenosine (short term), then catheter ablation
What is an accessory pathway causing Supraventrcualr tachycardia? WHAT LOOK LIKE IN ECG?
Basically an additional strip of muscle connecting the atria and ventricle, meaning that depolarisation can travel through it. Causes AV re-entrant tachycardia. Slurring between P and QRS complex, ind of merge together into one spike, so no individual P wave, and broader QRS complex.
What is atrial flutter?
Continual atrial depolarisation v fast.
Atrial fluuter ecg?
Shark tooth appearance,
How Atrial flutter treated? risk of what out?
Cathater ablation, can try and control with ventricular rate (betablockers, verapamil, digoxin, but a lot harder. If anticoagulated patient then will do a cardioversion.
