arrhythmias

Question 1

how to work out heart rate on ECG

Answer 1

count number of large squares between QRS complexes and divide 300 by that number

Question 2

what is the commonest rhythm, disturbance

Answer 2

atrial fibrillation

Question 3

atrial fibrillation pulse should be

Answer 3

irregularly irregular

Question 4

presentation of atrial fibrillation

Answer 4

palpitations, dyspnoea, chest pain, fatigue, embolism

Question 5

investigations of atrial fibrillation

Answer 5

document arrhythmia on ECG- 12 lead, 24 hour recording, event recorder, blood tests esp thyroid function, echocardiogram

Question 6

treatment of AF

Answer 6

rate control vs rhythm control. drugs, electrical approaches. consider anticoagulation eg NOACs or warfarin but risk of bleeding must be less than risk of stroke

Question 7

control of rate in AF

Answer 7

beta blockers, ca- antagonist,

Question 8

electrical approaches to AF treatment

Answer 8

if can’t control ventricular rate and patient remains symptomatic. pacemaker, ablation of AV node, substrate modification eg pulmonary vein isolation, surgical procedures

Question 9

control of rhythm in AF

Answer 9

digoxin versus class Ic, III drugs eg flecainide, amiodarone +/- DC cardioversion

Question 10

AV nodal reentrant tachycardia

Answer 10

AV nodal reentrant tachycardia. causes palpitations, dyspnoea, dizziness. has good prognosis- no treatment. adenosine treatment. if keeps recurring then catheter ablation is good with high success and low recurrence

Question 11

supra ventricular tachycardia

Answer 11

occurs above the ventricles..` AV nodal reentrant tachycardia, AV reentrant tachycardia, atrial flutter

Question 12

atrial flutter

Answer 12

blood going around the atrium, passes between the tricuspid valve and the vena cava, rapid, lots of atrial waves, will occur even after treatment so is best to ablate the area, prevent with AA drugs or RFA of cavotriscupid isthmus

Question 13

ventricular tachycardia

Answer 13

usually structural heart disease, palpitations, dizziness, CP, dyspnoea, syncope, do bloods echo angio etc.

Question 14

ventricular tachycardia on the ECG

Answer 14

waves up and down not normal just straight up straight down

Question 15

prevention of ventricular tachycardia

Answer 15

ICD, AntiArrhythmic drugs, physical exam, underlying cause

Question 16

termination of ventricular tachycardia

Answer 16

cardiac arrest protocol, DC cardioversion or drugs

Question 17

torsades de pointes

Answer 17

an uncommon and distinctive form of polymorphic ventricular tachycardia (VT) characterized by a gradual change in the amplitude and twisting of the QRS complexes around the isoelectric line. prolonged QT interval, which may be congenital or acquired

Question 18

long QT syndrome

Answer 18

congenital (autosomal dominant, gene mutation identification in most) or acquired (drugs). may cause TdP, physical exam, drugs, pacing or ICD

Question 19

Implantable cardioverter defibrillator ICD used when

Answer 19

secondary prevention. cardiac arrest due to VF/VT not due to transient or reversible cause eg early phase of acute MI, sustained VT causing syncope or significant compromise, sustained VT with poor LV function

Question 20

sick sinus syndrome

Answer 20

sinus node fails to create an impulse

Question 21

complete heart block

Answer 21

P wave is regular but they bear no relation to QRS complexes or ventricular activity

Question 22

mobitz 1

Answer 22

failure of AV node to conduct. produced by progressive fatigue of the AV nodal cells,

Question 23

mobitz 2

Answer 23

“all or nothing” phenomenon whereby the His-Purkinje cells suddenly and unexpectedly fail to conduct a supraventricular impulse.

Question 24

indications for permanent pacing

Answer 24

symptomatic or profound 2nd or 3rd degree AV block, particularly when cause is unlikely to disappear, probably mobitz II 2nd or 3rd degree AV block even If asymptomatic, AV block associated with neuromuscular disease, after or in prep for AV node ablation, alternating RBBB/LBBB, syncope when bifascicular/ trifascicular block and no other explanation, sinus node disease associated with symptoms, carotid sinus hypersensitivity/ malignant vasovagal syncope, poor LV function with LBBB

Question 25

careful history is essential for what

Answer 25

to distinguish the serious from the benign (benign requires no treatment just reassurance)

Question 26

what is essential for diagnosing arrhythmia

Answer 26

12 lead ECG along with symptom rhythm correlation if necessary with ambulatory monitoring