Arrhythmias Flashcards
(39 cards)
1
Q
What are arrhythmias?
A
Abnormal Heart rhythms
2
Q
Shockable rhythms
A
- Ventricular tachycardia
- Ventricular fibrillation
3
Q
Non shockable rhythyms
A
- Pulseless electrical activity(all electrical activity except VF/VT, including sinus rhythm without a pulse)
- Asystole
4
Q
What is A Fib
A
- chaotic irregular atrial arrhythmia and is considered a type of supraventricular tachycardia
- Most common A
- M > F
5
Q
RFs for A Fib
A
- Age
- DM
- HT
- Hyperthyroidism
- Congestive HF
- Valvular Heart disease
6
Q
A fib pathophysiology
A
- SA node produces electrical activity coordinates contraction of atria of heart
- A fib contraction of atria is uncoordinated, rapid and irregular - due to disorganised electrical activity overriding normal organised activity
7
Q
What does A Fib lead to?
A
Irregular conduction of impulses to ventricals - leads to:
- Irregularly irregularventricular contractions
- Tachycardia
- Heart failuredue topoor fillingof the ventricles duringdiastole
- Risk ofstroke
8
Q
Types of A fib
A
- First episode
- Paroxysmal: recurrent episodes that stop on their own in less than 7 days
- Persistent: recurrent episodes that last more than 7 days
- Permanent:
9
Q
Causes of A Fib - PIRATES
A
- Pulmonary- PE and COPD
- IHD
- Rheumatic heart disease
- Aneamia + Age
- Thyroid - hyper
- Electrolye - hypo/hyperkalemia
- Sepsis + Sleep apnoea
10
Q
S + S of Afib
A
- Irregular irregular pulse
- Hypotension:red flag; suggest haemodynamic instability
- Evidence of heart failure:red flag; such as pulmonary oedema
- Palpitations
- Dyspnoea
- Chest pain: red flag
- Syncope: red flag
11
Q
Features to do DC cardioversion with AFib
A
- Shock
- Syncope
- MI
- HF
12
Q
Investigations for Afib
A
- ECG: Irregularly irregular QRS complexes + absent P waves and chaotic baseline
- Serum electrolytes
- TFTs
13
Q
What do we have to for Afib management
A
- Determine if rate control or rhythm control is more appropriate
- Rate control - patient not in sinus rhythym - aim to get HR under 100
- Rhthym - restore normal sinus - known as cardioversion
14
Q
Haemodynamic unstable management
A
Unstable - Emergency electrical synchronised DC cardioversion
15
Q
Stable haemodynamically management
A
- Onset of AF < 48 hours: 1) rate control or 2) rhythm-control
- Onset of AF > 48 hours / unknown onset: offer rate-control and anticoagulation for at least 3 weeks, then offer rhythm control if appropriate e.g. if rate control is unsuccessful or the patient remains symptomatic
16
Q
Rate + Rhythym control
A
- Rate: 1st line - BB (Bisoprolol) or CCB (verapamil)/ Digoxin for patients with HF and AF just digoxin
- 2nd line Combine
- Rhythm control: Amiodarone or electrical cardioversion
17
Q
If treatment for Afib fails then what
A
- Left atrial ablation: thepulmonary veinssupply the premature depolarisations that trigger AF; radiofrequency energy is delivered in this area
18
Q
Complications of Afib
A
MI
Stroke
HF
Reduced quality of life
19
Q
What is atrial flutter
A
Atrial flutter is usually an organised atrial rhythm with an atrial rate typically between 250-350bpm
20
Q
Aetiology of Atrial flutter
A
- Idiopathic (30%)
- Coronary heart disease
- Obesity
- Hypertension
- Cardiomyopathy
- Heart failure
21
Q
What is the cause of atrial flutter?
A
- caused by a re- entrant rhythm in either atrium.
- electrical signal is in a self perpetuating loop due to an extra electrical pathway in the atria
22
Q
what is the rate of atrial contraction in atrial flutte
A
300bpm
23
Q
What would you see on an ECG for Atrial flutter
A
saw tooth shapes , p wave after p wave
24
Q
Assosciated conditions with atrial flutter
A
- Hypertension
- Ischaemic heart disease
- Cardiomyopathy
- Thyrotoxicosis
25
Aflutter treatment
- **Treat the reversible underlying condition** (e.g. hypertension or thyrotoxicosis)
- **Rate/rhythm control** with beta blockers or cardioversion
- **Radiofrequency ablation** of the re-entrant rhythm
- Same as A fib
26
What is wolf Parkinson White Syndrome
- caused by an extra electrical pathway causing the ventricles to contract early
- accessory pathway and av signal merge to contract both ventricles
- the extra pathway that is present is called the bundle of kent
27
2 types of WPWS
- Type A: +ve delta wave in V1
- Type B: -ve delta wave in V1
28
What can WPWS cause
Supraventricular tachycardia: may be due to AVRT or pre-excited AF/ flutter
29
ECG for WPWS
- Short pr interval
- wide qrs complex
- ’delta wave’ - a slurred upstroke on the qrs complex
30
Management of WFPW syndrome
- Flecainide, propafenone, sotalol, or amiodarone
- Ablation of the accessory pathway
31
Complications of WPWS
- **Prone to AF**
- May degenerate to **VF and cause sudden death**
32
What is SVT
Supraventricular tachycardia (SVT) is caused by the electrical signal re-entering the atria from the ventricles.
Elderly females affected
33
RFs for SVT
- **Increasing age**: five times more common in elderly patients
- **Female gender**: two times more common in females
- **Hyperthyroidism**
- **Smoking**
- **Excessive caffeine or alcohol consumption**
34
SVT main types
WPWS
A FIB + FLUTT
Paroxysmal
35
Pathophysiology of SVT
Elec signals finds way back from ventricles to atria - once back travels back through AV node causing another ventricular contraction
QRS <0.12
36
What is Atrioventricular nodal reentry tachycardia (AVNRT)
when the re-entry point is back through the AV node.
37
ECG for AVNRT
12-lead ECG: regular, narrow-complex tachycardia (QRS <0.12) with a rate of 151 to 250 beats per minute - it looks like a QRS complex followed immediately by a T wave, QRS complex, T wave etc
38
S + S of SVT
- **Tachycardia + Tachypnoea**
- **Hypotension**
- **Pallor**
- **Cold and clammy**
- **Palpitations**
- **Shortness of breath**
- **Chest pain**
39
Long term management of those with SVT
- Medication (**beta blockers**, **calcium channel blockers** or **amiodarone**)
- **Radiofrequency ablation**
