Arrhythmias

Question 1

What are the main types of supraventrucular arrhythmias?

Answer 1

Atrial fibrillation
Atrial flutter
Ectopic Heart Beat

Question 2

What are the main types of ventricular arrhythmias?

Answer 2

Ventricular tachycardia
Ventricular fibrillation
Asystole

Question 3

What type of arrhythmia is AV block?

Answer 3

AV node arrhytmia

Question 4

What is an anatomical abnormality that can cause arrhythmia?

Answer 4

Left ventricular hypertrophy
accessory pathways
congenital heart disease

Question 5

What alteration of the autonomic nervous system can cause arrhythmias?

Answer 5

sympathetic stimulation (stress, exercise etc.)
Increased vagal tone

Question 6

What are the metabolic causes of arrhythmia?

Answer 6

Hypoxia (from COPD)
ischaemic myocardium
electrolyte imbalances

Question 7

what is an inflammatory cause of arrhythmia?

Answer 7

Viral myocarditis

Question 8

What is an example of a genetic cause of arrhythmia?

Answer 8

long QT syndrome

Question 9

Ectopic foci in muscle sleeves in the ostia of pulmonary veins that release signals which override SA node conduction is the mechanism of which arrhythmia type?

Answer 9

AF

Question 10

AF lasting <48 hrs and is recurrent. what type of AF?

Answer 10

Paroxysmal

Question 11

AF lasting >48 hrs (with the ability to be converted back to sinus rhythm) and is unlikely to undergo spontaneous cardioversion. what type of AF?

Answer 11

Persistent

Question 12

AF that is long term and cannot be converted back to sinus rhythm. what type of AF?

Answer 12

perminant

Question 13

what are some diseases associated with AF?

Answer 13

congestive heart failure
hypertension
obesity
CHD
congenital heart disease
many more

Question 14

What is lone AF?

Answer 14

idiopathic atrial fibrillation
thought to be related to genetics
increases chance of stroke in >75s

Question 15

What are the main symptoms of AF?

Answer 15

palpitations
dizziness
syncope
chest pain
dyspnoea
sweatiness
fatigue

Question 16

what is the atrial rate in AF typically?

Answer 16

> 300bpm

Question 17

what rhythm is associated with AF?

Answer 17

irregularly irregular

Question 18

what can effect the ventricular rate in AF?

Answer 18

AV node conduction
Sympathetic/parasympathetic tone
drugs that act on the AV node

Question 19

how would you recognise atrial fibrillation on an ECG?

Answer 19

no P waves present

presence of F waves

Question 20

what is the characteristic ECG appearance of atrial flutter?

Answer 20

“saw-tooth” F-waves

Question 21

Cardiac output is decreased in atrial fibrillation. true or false?

Answer 21

TRUE

Question 22

AF cannot lead to congestive heart failure. true or false?

Answer 22

FALSE

it can- especially with diastolic dysfunction

Question 23

What type of drug is commonly prescribed in both cases of rhythm control and rate control of AF?

Answer 23

anti-coagulants- high thromboembolism risk

Question 24

What drugs can slow AV node conduction?

Answer 24

Digoxin
B-Blockers (such as bisoprolol)
CCBs (such as verapamil, diltiazem)

Question 25

What are the two types of cardioconversion for restoring NSR in AF?

Answer 25

Pharmacological | direct current/ electrical

Question 26

what are the 3 main options to maintain NSR in AF?

Answer 26

anti-arrhytmic drugs catheter ablation of atrial focus/ pulmonary veins Surgery (maze procedure)

Question 27

which VW classes of antiarrhythmics are used for rhythm control in AF?

Answer 27

IA, IB, IC | III

Question 28

what VW classes of antiarrhythmics are used for rate control in AF?

Answer 28

II IV V

Question 29

Which anti-arrhythmic class depress AP phase 0?

Answer 29

IA, IB, IC

Question 30

which anti-arrhythmic class depress AP phase 4?

Answer 30

II

Question 31

which anti-arrhythmic class affects AP phase 3?

Answer 31

III

Question 32

which anti-arrhythmic class depresses phase 2 of AP?

Answer 32

IV

Question 33

examples of IA antiarrhythmics?

Answer 33

quinidine sulfate | hydroquinidine

Question 34

examples of IB antiarrhythmics?

Answer 34

lidocaine mexilitene tocainide

Question 35

examples of IC antiarrhythmics?

Answer 35

flecainide | propafenone

Question 36

examples of II antiarrhythmics?

Answer 36

Beta blockers: eg. bisoprolol

Question 37

examples of III antiarrhythmics?

Answer 37

amiodarone dronedarone sotalol

Question 38

examples of IV antiarrhythmics?

Answer 38

Calcium channel blockers: eg verapamil, diltiazem

Question 39

examples of V antiarrhythmics?

Answer 39

digoxin adenosine magnesium sulphate (for torsades de pointes ONLY)

Question 40

``` HR of 200-250 bpm irregularly irregular rhythm long QT interval wide QRS changing QRS morphology what does this indicate? ```

Answer 40

Torsades de Pointes

Question 41

what would put you at a higher risk of thromboembolism?

Answer 41

``` valvular heart disease (mitral stenosis > mitral regurg.) over 75 y/o + female hypertension heart failure PMH of thromboembolism/stroke CHD + diabetes + >60 y/o thyrotoxicosis ```

Question 42

what makes up the CHA(2)DS(2)- VAS score?

Answer 42

``` congestive heart failure hypertension age >_ 75 (2 points) diabetes stroke (2 points) vascular disease age 65-74 sex (female) ```