Arrhythmias Flashcards Preview

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Flashcards in Arrhythmias Deck (40):
1

What are the two classes of arrhythmias described by where the arrhythmia arises?

Supraventricular
Ventricular

2

Supraventricular arrhythmias tend to have narrow QRS complexes. True/False?

True
Because the arrhythmia does not originate from ventricles

3

The AV node is the only point of electrical contact between the atria and ventricles. What may additionally be present to cause pathological conduction?

Fibrous ring

4

What are ectopic beats?

Beats/rhythms that originate outwith the SA node

5

Ectopic beats may not be dangerous. True/False?

True

6

Why might ectopic beats not be harmful?

Depends on where they originate - if in non-contractile areas, they are unlikely to affect cardiac output

7

Name the main supraventricular arrhythmias

SVTs: atrial fibrillation, atrial flutter, ectopic atrial tachycardia
Bradycardias: sinus bradycardia, sinus pauses

8

Name the main AV node arrhythmias

AV node reentry
Accessory pathway
AV block (1st, 2nd, 3rd degree)

9

Name the main ventricular arrhythmias

Premature ventricular complex
Ventricular tachycardia
Ventricular fibrillation
Asystole

10

What are the 3 main physiological types of arrhythmia?

Altered automaticity
Triggered activity
Reentry (accessory pathway)

11

List the investigations you would do for arrythmias

ECG/exercise ECG/24hr ECG
CXR
Echocardiogram
Event recorder
EP study (induce arrhythmia to map pathway)

12

How would acute SVT be managed?

Vagal manoeuvres, carotid massage
IV adenosine
IV verapamil

13

Give examples of some vagal manoeuvres

Holding your breath and bearing down (Valsalva)
Immersing face in ice-cold water (diving reflex)
Holding nose/unblocking ears

14

What is the treatment of choice for managing chronic arrhythmias?

Radiofrequency ablation

15

What is radiofrequency ablation?

Selective cauterisation of cardiac tissue to prevent tachycardia
Target reentry circuit or automatic myocite

16

Which drugs must be stopped before radiofrequency ablation?

Antiarrhythmic drugs 3-5 days beforehand

17

What is notorious for causing AV block in young people?

Cytomegalovirus

18

Describe 1st degree AV block

PR interval increased (greater than 0.2s)

19

Describe 2nd degree Mobitz 1 AV block

PR interval gets progressively longer, followed by dropped QRS

20

Describe 2nd degree Mobitz 2 AV block

Lonely P waves not followed by QRS
N.B. PR interval not prolonged

21

Describe 3rd degree AV block

P waves without QRS complexes
i.e. no association between atrial and ventricular systole

22

What is typical of an ECG showing ventricular tachycardia?

Broad QRS complexes

23

What is the difference between monomorphic and polymorphic VT?

In monomorphic VT, the QRS complexes look similar

24

How would acute VT be treated?

DC cardioversion if unstable
Adenosine if unsure it's VT

25

What are the 3 classifications of AF?

Paroxysmal
Persistent
Permanent

26

Define paroxysmal AF

Recurrent AF, lasting less than 48 hours

27

Define persistent AF

AF lasting greater than 48 hours which can be cardioverted to normal sinus rhythm

28

Define permanent AF

AF that is unable to be restored to normal sinus rhythm via pharma + non pharmacological methods

29

What is meant by lone AF?

AF where a cause cannot be found

30

What would a typical ECG of AF show?

Rate greater than 300bpm
Irregularly irregular
P waves absent

31

What are the two management pathways for AF patients?

Rhythm control (get back to NSR)
Rate control (accept AF, control ventricular rate)

32

What pharmacological therapy can be used for rate control in AF?

Digoxin
B blockers
Verapamil, diltiazem

33

How can NSR be restored in AF (rhythm control)?

Amiodarone
DC cardioversion

34

Class I anti-arrhythmic drugs act on which phase of the AP and block which channels?

Act on phase 0
Block Na+ channels

35

Name a class I anti-arrhythmic drug

Flecainide
Lignocaine

36

Class II anti-arrhythmic drugs act on which phase of the AP and block which channels?

Act on phase 4
Block B receptors (B blockers)

37

Class III anti-arrhythmic drugs act on which phase of the AP and block which channels?

Phase 3
Block K channels

38

Name a class III anti-arrhythmic drug

Amiodarone
Sotalol

39

Class IV anti-arrhythmic drugs act on which phase of the AP and block which channels?

Phase 2
Block Ca channels

40

What would a typical ECG of atrial flutter look like?

Saw tooth baseline
Regular rhythm