arrhythmias

Question 1

first line management SVT if patient stable

Answer 1

vagal manoeuvres - carotid sinus massage, valsalva manoeuvre

Question 2

second line management SVT if patient stable

Answer 2

IV adenosine 6mg, if this fails - another 12mg, followed by another 12mg

Question 3

contraindications adenosine

Answer 3

• asthma
• COPD
• heart failure
• heart block
• severe hypotension

Question 4

what type of MI tends to cause mobitz II heart block

Answer 4

anterior MI

Question 5

management bradycardia if adverse signs present or risk of asystole

Answer 5

atropine 500mcg IV
if unsatisfactory:
- 500mcg atropine upped to 3mg
- transcutaneous pacing
- isoprenaline/adrenaline infusion

Question 6

definition persistent AF

Answer 6

> 7 days - requires electrical or chemical cardioversion

Question 7

definition permanent AF

Answer 7

• Fail to terminate with cardioversion OR
• Terminated episode relapses within 24 hours OR
• Long standing AF - cardioversion not indicated or attempted

Question 8

causes AF

Answer 8

SMITH
- Sepsis
- Mitral regurg
- Ischaemic heart disease
- Thyrotoxicosis
- Hypertension

Question 9

MOA adenosine

Answer 9

• causes transient heart block in AV node
• A1 receptor agonist in AV node

Question 10

how should adenosine be administered? and why

Answer 10

• large-calibre cannula due to its short half life