arrhythmias

Question 1

what is the issue in AV block

Answer 1

impaired conduction between atria and ventricles

Question 2

what is 1st degree heart block

Answer 2

PR interval >0.2 seconds

Question 3

how is 1st degree HB managed

Answer 3

does not need treatment

Question 4

what is 2nd degree HB (Mobitz I)

Answer 4

PR interval lengthens until a dropped beat occurs

Question 5

what is 2nd degree HB (Mobitz II)

Answer 5

PR interval is constant but there are occasional dropped QRS’s (3:1 or 2:1)

Question 6

what is 3rd degree heart block

Answer 6

no association between P waves + QRS

Question 7

symptoms of heart block

Answer 7

syncope // HF // wide pulse pressure // regular bradycardia //JVP cannon waves // variable S1

Question 8

in unstable heart block what mx is recommended

Answer 8

IV atropine x2 –> IV adrenaline –> trancut pacing eg defib

Question 9

how is AV block mobitz type II or complete heart block managed

Answer 9

temporary cardiac pacing –> permanent pacemaker

Question 10

how is complete heart block following a posterior MI managed differently

Answer 10

if haenodynamically stable can observe

Question 11

what conditions does supraventricular tachycardia cover (4)

Answer 11

any tachycardia not from ventricles: normal tachycardia // AV nodeal re-entry tachy (AVNRT) // AV re-entry tachycardias (AVRT) // junctional tachycardias

Question 12

how do SVTs present + what type of QRS

Answer 12

sudden onset and termination // narrow complex QRS

Question 13

what 1st line non medical management can be done in SVTs

Answer 13

vagal manouvres eg vasalva // carotid sinus massage

Question 14

what 2nd and 3rd line mx for SVTs

Answer 14

IV adenosine (6mg–>12–>18) –> direct current cardioversion

Question 15

what can be given instead of adenosine in SVTs and what type of patients mayrequire it

Answer 15

verapamil - asthmatics

Question 16

what can be done for longterm prevention of SVT episodes

Answer 16

BB // radio frequency ablation

Question 17

where is the reentry point in AVNRT

Answer 17

AV node

Question 18

where is the rentry point in AVRT

Answer 18

accessory pathways eg purkinje fibres

Question 19

what are vaslava manouvres used for

Answer 19

terminate SVT + normalise middle ear pressure

Question 20

what commonly causes monoporphic v tach

Answer 20

MI

Question 21

what commonly causes polymorphic v tach

Answer 21

long QT –> torsades de pointes

Question 22

in an unstable patient how should V tach be treated

Answer 22

ALS guidelines (pulseless v tach or V fib)

Question 23

drug management V tach

Answer 23

amiodarone // lidocaine // procainamide

Question 24

if drug therapy fails what mx for ventricular tachycardia

Answer 24

EPS or ICD (implantable cardio-defib)

Question 25

what drug should be avoided in v tach

Answer 25

verapamil

Question 26

what can v tach progress too

Answer 26

v fib

Question 27

what is torsades de pointes

Answer 27

polymorphic V tach with long QT

Question 28

what congenital conditions can cause long QT

Answer 28

Jervell-lange + romano ward

Question 29

what meds can cause torsades de points

Answer 29

antiarrhythmics eg amiodarone // TCAs + SSRIs // antipsychotics eg haloperidol // anti-histamine eg terfenadine // sotalol

Question 30

what abx can cause torsades de poinrs

Answer 30

erythrmoycin + chloroquine

Question 31

what cocnditions can cause torsades de pointes (4)

Answer 31

hypoK/Ca/Mg // myocarditis // hypothermia // SAH

Question 32

mx torsades de ponts

Answer 32

IV mag sulphate

Question 33

what is long QT syndrome + what is the common variant

Answer 33

inherited condition which delays depolarisation of ventricles // slow K channel

Question 34

what is long QT1 assoc with

Answer 34

exercise syncope esp swimming

Question 35

what is long QT2 assoc with

Answer 35

syncope with emotional, excercise or auditory

Question 36

what is long QT3 assoc with

Answer 36

sudden events at night or rest

Question 37

what drug management for long QT

Answer 37

BB EXCEPT SOTALOL

Question 38

if drugs fail what mx for long QT

Answer 38

impantable cardio defib (ICD)

Question 39

what type of arrhythmia is WPW

Answer 39

SVT --> AVRT from accessory conducting pathway

Question 40

ECG features WPW

Answer 40

short PR // wide QRS + delta wave // left (right accessory) or right axis (left accessory) deviation

Question 41

how can you differentiate between left and rights sided WPW on ECG

Answer 41

left pathway (type A) = dominant R wave in V1 // right pathway (type B) = no dominant R wave V1

Question 42

what is WPW assoc with (5)

Answer 42

HCOM // mitral prolapse // thryoid problem // ASD // ebsteins

Question 43

mx WPW

Answer 43

radiofrequency ablation

Question 44

mx WPW

Answer 44

antiarrhymics eg BB blockers, amiodarone, flecainide

Question 45

what 1st line invx should all patients with palpitations receive

Answer 45

ECG // TFT // U+E // FBC

Question 46

DVLA after explained + treated syncope episode

Answer 46

4 weeks