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Finals - CardioResp > Arrhythmias > Flashcards

Arrhythmias Flashcards

(59 cards)

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1
Q

How can arrhythmias be divided?

A

Tachyarrhythmia and Bradyarrhythmia

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2
Q

List 4 examples of Bradyarrhythmias

A
  1. Sick sinus syndrome
  2. Sinus bradycardia
  3. Heart blocks
  4. BBB
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3
Q

What is sick sinus syndrome?

A

Sinus node becomes dysfunctional due to sinus node fibrosis.

Typically affects the elderly

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4
Q

How does sick sinus syndrome affect the rate/rhythm of the heart?

A

Can cause sinus bradycardia, pauses, sinus tachycardia or AF

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5
Q

What does this ECG of sick sinus syndrome show?

A

“pauses” due to sinus exit block/sinus arrest

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6
Q

Sick sinus syndrome causes chronotropic incompetence, what does this mean?

A

Inability to increase and maintain HR appropriately during exercise

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7
Q

Treatment of sick sinus syndrome (3)

A
  1. Conservative - asymptomatic
  2. Correct reversible causes
  3. Pacemaker for symptomatic bradycardia or sinus pauses
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8
Q

What is heart block?

A

Communication problem between he atria and ventricle

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9
Q

What is first degree heart block?

A

P-R interval elongation 0.20 seconds (5 small/1 big square) due to conduction delay at the AV node

All signals reach the ventricles

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10
Q

What are the 2 types of second degree heart block?

A
  1. Mobitz type 1 (Type 1) ‘Wenkebach’
  2. Mobitz type 2 (Type )
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11
Q

Compare Mobitz 1 vs 2

A

Excitation sometimes fails to pass through the AV node or bundle of His

Type 1: P-R interval elongation, then QRS dropped

Types 2: Constant P-R interval, then QRS dropped

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12
Q

What is Complete (third degree) heart block?

A

Atrial contractions are normal but NO electrical activity conveyed to the ventricles

Ventricles generate their own signal through ectopic pacemaker

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13
Q

Treatment of heart block?

A
  1. Conservative if asymptomatic and not high risk
  2. Correct reversible causes
  3. Pacemaker if symptomatic or high degree block
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14
Q

What is the biggest risk of complete degree heart block?

A

Risk of sudden death

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15
Q

Are pacemakers used to treat brady, tachy or both types of arrythmias?

A

Bradyarrhythmias

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16
Q

List patient groups who are high risk for asystole

A
  1. Mobitz Type 2
  2. Complete heart block
  3. Previous asystole
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17
Q

Treatment of Bradycardias?

A
  1. First line: Atropine 500mcg IV
  2. No improvement: Repeat Atropine (total of 3mg) OR Adrenaline OR Transcutaneous cardiac pacing
  3. Transvenous cardiac pacing
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18
Q

What is Atropine

List 2 s/e

A

antimuscarinic - inhibits the PNS

S/e: pupil dilatation, urinary retention, dry eyes and constipation

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19
Q

List 4 examples of Tachyarrhythmias

A
  1. AF or Atrial flutter
  2. SVT
  3. VT or VF
  4. Sinus tachycardia
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20
Q

List 4 risk factors for atrial flutter

A
  1. Obesity
  2. Hypertension
  3. Drugs (alcohol)
  4. Structural heart disease (valves, congenital, cardiomyopathy)
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21
Q

What ECG change is characteristic of Atrial fibrillation

A

Absent P waves

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22
Q

How does AF present?

A
  1. palpitations
  2. dyspnoea
  3. chest pain
  4. an irregularly irregular pulse
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23
Q

What are the two key parts of managing patients with AF

A
  1. Rate/rhythm control
  2. Reducing stroke risk
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24
Q

How do assess risk of stroke in a patient with AF

What values indicate anticoagulation is required?

Study These Flashcards
A

CHA2DS2-VASC score

Anticoagulation if >1 male or >2 female

25
How is rate control achieved in AF
First line: BB or a rate-limiting CCB (e.g. diltiazem) Second line is combination therapy with any 2 of the following: * a betablocker * diltiazem * digoxin
26
What is a contraindication to use of BB in AF?
Asthma
27
How is rhythm control achieved in AF
Cardioversion
28
When is a patient with AF eligible for cardioversion
1. cardioversion if less than 48 hours OR 2. anticoagulation for 3-4wks prior to attempting cardioversion
29
Why do we NOT cardiovert an patient who had had AF symptoms \>48hrs?
If a thrombus has formed, the moment patient switches from AF to sinus rhythm there is a high risk of embolism leading to stroke
30
Like 4 causes of Atrial flutter
Same as AF
31
Compare the risk of stroke in AF vs atrial flutter
AF higher risk
32
Compare treatment of AF vs atrial flutter
Same rate control vs. rhythm control strategy Atrial flutter harder to rate control but easier to cardiovert or ablate
33
What is SVT
Regular narrow complex tachycardias which originate above the ventricle
34
What are the 2 types of SVT?
AVNRT and AVRT
35
What is AVNRT
AV nodal re-entry tachycardia Rapidly firing circuit within the AV node
36
What is AVRT?
Atrioventricular re-entry tachycardia uses an accessory pathway (a “short circuit” between atrium and ventricle) and the AV node to make a circuit
37
Which type of SVT is more common?
AVNRT
38
What are the 2 ways we can classify AVRT
“orthodromic” (going through AV node in normal direction) “antidromic” (going through AV node backwards)
39
Treatment of SVT
First line: vagal manoeuvres (carotid sinus massage, valsalva) Second line: adenosine
40
What is Wolff-Parkinson-White?
Clinical syndrome of tachyarrhythmias and pre-excitation on ECG
41
What is the characteristic ECG changes of WPW
Delta wave and P-R shortening
42
Treatment of WPW
Ablation of the bundle of kent
43
What is VT and VF?
Regular broad-complex tachycardias originating in ventricles
44
How do VT and VF present?
1. palpitations 2. heart failure/shock 3. syncope 4. sudden death
45
How dangerous is VT vs VF?
VT is usually dangerous (though not always – “normal heart VT”) VF is always dangerous
46
Treatment of VT and VF?
Hemodynamically stable: IV amiodarone Hemodynamically unstable: Immediate cardioversion
47
What are the two types of VT?
1. Monomorphic VT: most commonly caused by MI 2. Polymorphic VT (subtype is torsades de pointes)
48
What is Monomorphic Ventricular Tachycardia?
Usually caused by a scar in the ventricle Most commonly prior MI but can be due to scarring from other processes (e.g. cardiomyopathy, sarcoidosis)
49
What is PVT
Usually caused by ectopic beat in vulnerable period (“R-on-T”) Usually no cardiac output
50
What is Torsades-de-pointes
'Twisting of the points' - Subtype of PVT Characterised by a long QT interval due to rotating QRS axis
51
How do you treat Torsades de pointes?
IV magnesium sulphate
52
List 4 causes of PVT
Anything causing QT prolongation eg. electrolyte abnormalities (low K/Ca/Mg), acute ischaemia, bradycardia, long QT syndrome
53
Treatment of PVT?
Often self-terminating Otherwise needs cardioversion with thump or DC shock Treatment involves correcting cause and overdrive pacing
54
List 4 causes of VF
1. myocardial acidosis 2. acute ischaemia (i.e. current MI) 3. ventricular scarring 4. electrolyte abnormalities
55
Treatment of VF
IMMEDIATE defibrillation or death will ensue
56
Following restoration of sinus rhythm, what is generally offered to most patients with VT/VF
ICD
57
Revise Tachycardia treatment algorithm
58
What are the 2 ways Cardioversion is achieved?
1. Pharmacological CV: Flecanide, Amioderone 2. Electrical CV
59
What are the 4 Cardiac Arrest Rhythms Incl which are shockable/non-shockable
Shockable rhythms: VT and VF Non-shockable rhythms: PEA and Asystole

Finals - CardioResp (18 decks)

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