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Y1 CARDIOLOGY > Arrhythmias > Flashcards

Arrhythmias Flashcards

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1
Q

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

A

Supraventricular

Ventricular

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2
Q

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

A

True

Because the arrhythmia does not originate from ventricles

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3
Q

What are ectopic beats? How are they treated?

A

Beats/rhythms that originate outwith the SA node - typically present as palpitations
Avoid stimulants, B blockers, nothing

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4
Q

Ectopic beats may not be dangerous. True/False?

A

True

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5
Q

Why might ectopic beats not be harmful?

A

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

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6
Q

Name the main supraventricular arrhythmias

A

SVTs: atrial fibrillation (atria beat rregularly), atrial flutter (atria beat regularly but faster than usual), ectopic atrial tachycardia
Bradycardias: sinus bradycardia (<60 bpm), sinus pauses (SAN doesnt stimulate impulse)

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7
Q

Name the main AV node arrhythmias

A 
AV node reentry
Accessory pathway
AV block (1st, 2nd, 3rd degree)
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8
Q

Name the main ventricular arrhythmias

A

Premature ventricular complex (ectopic beat from purkinje fibres)
Ventricular tachycardia
Ventricular fibrillation
Asystole

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9
Q

What are the 3 main physiological types of arrhythmia?

A

Altered automaticity
Triggered activity
Reentry (accessory pathway)

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10
Q

List the investigations you would do for arrythmias

A 
ECG/exercise
ECG/24hr 
ECG
CXR
Echo
Event recorder
EP study (induce arrhythmia to map pathway)
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11
Q

How would acute SVT be managed?

A

Vagal manoeuvres, carotid massage, IV adenosine, IV verapamil

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12
Q

Give examples of some vagal manoeuvres

A

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

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13
Q

What is the treatment of choice for managing chronic arrhythmias?

A

Radiofrequency ablation

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14
Q

What is radiofrequency ablation?

A

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

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15
Q

Which drugs must be stopped before radiofrequency ablation?

A

Antiarrhythmic drugs 3-5 days beforehand

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16
Q

What is notorious for causing AV block in young people?

A

Cytomegalovirus

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17
Q

Describe 1st degree AV block

A

PR interval increased (greater than 0.2s)

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18
Q

Describe 2nd degree Mobitz 1 AV block

A

PR interval gets progressively longer, followed by dropped QRS

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19
Q

Describe 2nd degree Mobitz 2 AV block

A

Lonely P waves not followed by QRS - QRS wave dropped every nth time
N.B. PR interval not prolonged

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20
Q

Describe 3rd degree AV block

A

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

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21
Q

What is typical of an ECG showing ventricular tachycardia?

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A

Broad QRS complexes

22
Q

What is the difference between monomorphic and polymorphic VT?

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A

In monomorphic VT, the QRS complexes look similar

Polymorphic is disorganised (Torsades de Pointes)

23
Q

How would acute VT be treated?

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A

DC cardioversion if unstable

Adenosine if unsure it’s VT

24
Q

What are the 3 classifications of AF?

Study These Flashcards
A

Paroxysmal
Persistent
Permanent

25
Define paroxysmal AF
Recurrent AF, lasting less than 48 hours
26
Define persistent AF
AF lasting greater than 48 hours which can be cardioverted to normal sinus rhythm
27
Define permanent AF
AF that is unable to be restored to normal sinus rhythm via pharma + non pharmacological methods
28
What is meant by lone AF?
AF where a cause cannot be found
29
What would a typical ECG of AF show?
Rate greater than 300bpm Irregularly irregular P waves absent
30
What are the two management pathways for AF patients? What must you always consider?
``` Rhythm control (get back to NSR) Rate control (accept AF, control ventricular rate) ANTICOAGULATION ```
31
What pharmacological therapy can be used for rate control in AF?
Digoxin B blockers Verapamil
32
How can NSR be restored in AF (rhythm control)?
Amiodarone Class I and III anti-arrhythmics DC cardioversion
33
Class I anti-arrhythmic drugs act on which phase of the AP and block which channels?
Act on phase 0 - increase time spent in open and inactivated states to normalise beating frequency Block Na+ channels
34
Name a class I anti-arrhythmic drug
1C: slow rate - Flecainide 1B: rapid rate - Lignocaine 1A: moderate rate - Disopyramide
35
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)
36
Class III anti-arrhythmic drugs act on which phase of the AP and block which channels?
Phase 3 | Block K channels
37
Name a class III anti-arrhythmic drug
Amiodarone | Sotalol
38
Class IV anti-arrhythmic drugs act on which phase of the AP and block which channels? Give an example
Phase 2 Block Ca channels Verapamil
39
What would a typical ECG of atrial flutter look like?
Saw tooth baseline | Regular rhythm
40
What are the typical symptoms of arrhythmia?
``` Palpitations SOB Dizziness Syncope/pre-syncope (faintness) Chest pain Fatigue Sweatiness Worsening angina, CHF ```
41
In what situation is sinus bradycardia normal? How is it treated?
Athletes Atropine acutely Pacing if haemodynamic collapse
42
In what situation is sinus tachycardia normal? How is it treated?
Anxiety, fever, hypotension, anaemia | B blockers, change medications
43
What would Wolf Parkinson White syndrome look like on an ECG?
Broad QRS with slurred upstroke on R wave | 'Delta wave'
44
How is heart blocked treated?
Ventricular pacing
45
What are some causes of AF?
``` Heart surgery Hypertension Alcohol abuse Coronary HD Thyroid D Obesity/ athletes Valvular HD Familial ```
46
What score is used to estimate the need for anticoagulation in AF?
CHAD2VASC score
47
What would hyperkalaemia look like on an ECG?
Tall tented T waves | Wide QRS
48
What is the most common cause of sudden cardiac death in young people?
Hypertrophic cardiomyopathy
49
What drugs are used most commonly in SV arrhythmias?`
Adenosine Digoxin Verapamil
50
What drug is used most commonly in V arrhythmias?
Amiodarone | Lignocaine
51
What are some common side effects of anti-arrhythmic drugs?
Phototoxicity Pulmonary fibrosis Peripheral neuropathy Thyroid abnormalities

Y1 CARDIOLOGY (16 decks)

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