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Cardiovascular 2 > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What are arrhythmias?

A

Abnormal Heart rhythms

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2
Q

Shockable rhythms

A
  • Ventricular tachycardia
  • Ventricular fibrillation
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3
Q

Non shockable rhythyms

A
  • Pulseless electrical activity(all electrical activity except VF/VT, including sinus rhythm without a pulse)
  • Asystole
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4
Q

What is A Fib

A
  • chaotic irregular atrial arrhythmia and is considered a type of supraventricular tachycardia
  • Most common A
  • M > F
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5
Q

RFs for A Fib

A
  • Age
  • DM
  • HT
  • Hyperthyroidism
  • Congestive HF
  • Valvular Heart disease
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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
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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
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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:
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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
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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
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11
Q

Features to do DC cardioversion with AFib

A
  • Shock
  • Syncope
  • MI
  • HF
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12
Q

Investigations for Afib

A
  • ECG: Irregularly irregular QRS complexes + absent P waves and chaotic baseline
  • Serum electrolytes
  • TFTs
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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
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14
Q

Haemodynamic unstable management

A

Unstable - Emergency electrical synchronised DC cardioversion

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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
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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
Q

Aflutter treatment

A
  • Treat the reversible underlying condition (e.g. hypertension or thyrotoxicosis)
  • Rate/rhythm controlwith beta blockers or cardioversion
  • Radiofrequency ablationof the re-entrant rhythm
  • Same as A fib
26
Q

What is wolf Parkinson White Syndrome

A
  • 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
Q

2 types of WPWS

A
  • Type A: +ve delta wave in V1
  • Type B: -ve delta wave in V1
28
Q

What can WPWS cause

A

Supraventricular tachycardia: may be due to AVRT or pre-excited AF/ flutter

29
Q

ECG for WPWS

A
  • Short pr interval
  • wide qrs complex
  • ’delta wave’ - a slurred upstroke on the qrs complex
30
Q

Management of WFPW syndrome

A
  • Flecainide, propafenone, sotalol, or amiodarone
  • Ablation of the accessory pathway
31
Q

Complications of WPWS

A
  • Prone to AF
  • May degenerate to VF and cause sudden death
32
Q

What is SVT

A

Supraventricular tachycardia (SVT) is caused by the electrical signal re-entering the atria from the ventricles.
Elderly females affected

33
Q

RFs for SVT

A
  • 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
Q

SVT main types

A

WPWS
A FIB + FLUTT
Paroxysmal

35
Q

Pathophysiology of SVT

A

Elec signals finds way back from ventricles to atria - once back travels back through AV node causing another ventricular contraction
QRS <0.12

36
Q

What is Atrioventricular nodal reentry tachycardia (AVNRT)

A

when the re-entry point is back through the AV node.

37
Q

ECG for AVNRT

A

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
Q

S + S of SVT

A
  • Tachycardia + Tachypnoea
  • Hypotension
  • Pallor
  • Cold and clammy
  • Palpitations
  • Shortness of breath
  • Chest pain
39
Q

Long term management of those with SVT

A
  • Medication (beta blockers,calcium channel blockersoramiodarone)
  • Radiofrequency ablation

Cardiovascular 2 (10 decks)

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