Arrhythmias

Question 1

causes of arrhythmias cardiac

Answer 1

IHD
mitral valve disease
cardiomyopathy
peri/myocarditis
aberrant conduction pathways

Question 2

non cardiac causes of arrhythmias

Answer 2

caffeine
smoking
alc
pneumonia
drugs
metabolic imbalance

Question 3

px arrhythmia

Answer 3

palps
chest pain
presyncope (lightheadedness
syncope
hypotension

Question 4

ix arrhythmias

Answer 4

FBC
U+E
glucose
ca
mg
TSH
ECG
echo

Question 5

if you can’t spot an arrhythmia on an ecg

Answer 5

24 ecg

if still not captured, implantable loop recorder

Question 6

treatment of bradycardia

Answer 6

asymptomatic and >40bpm -> no rx
symptomatic/<40bpm -> atropine
NB LOOK FOR CAUSE

Question 7

what type of drug is atropine

Answer 7

mAChR antagonist

Question 8

what is sick sinus syndrome

Answer 8

not specific disease - group of abnormal arrhythmias due to sinus node dysfunction
cause bradycardia+/-arrest
variant called tachy-brady syndrome - alternates between SVT and bradycardia/asystole

Question 9

rx sick sinus syndrome

Answer 9

pace if symptomatic

Question 10

SVT rx (incl acute and maintenance)

Answer 10

vagotonic manoeuvres
followed by IV adenosine.
IV verapamil if not successful (NOT IF ON BB)
DC shock if compromised

maintenance: BB or verapamil

Question 11

SVT vs VT size of QRS

Answer 11

SVT -> narrow

VT -> broad (only other cause of broad is branch block?)

Question 12

acute and maintenance rx VT

Answer 12

IV amiodarone or IV lidocaine.
MgSO4 if torsades de pointes
DC shock if no response of compromised. also give amiodarone
maintenance = amiodarone

Question 13

what are included in vagal manoeuvres

Answer 13

breath holding
carotid sinus massage
valsalva manoeuvre
these cause transient AV block and can terminate the SVT

Question 14

what does adenosine do

Answer 14

cause transient AV block

Question 15

risk in SVT

Answer 15

stroke?

Question 16

Mr Hunter’s 2 step rule for ECG with wide QRS

Answer 16

1. VT until proven otherwise
2. see 1.

i.e. basically always treat as VT because this could kill the pt if you don’t

Question 17

rx VF or unstable VT

Answer 17

aysnchronised DC shock (+ probably will resuscitate)

Question 18

in what do fusion beats occur? what are they?

Answer 18

VT
normal beat fuses with VT complex to create an unusual complex (the SA node is still beating normally in VT but a lot slower. occasionally it’s beats manage to transfer to ventricles so when this happens at the same time as the ventricles are randomly beating, it can lead to a funny looking complex)

Question 19

in what do capture beats occur? what are they?

Answer 19

VT
normal QRS seen in between VT complex -> just by chance, a beat has been started in the atria and normally conducted to the ventricles

Question 20

what is stokes adams

Answer 20

clinical diagnosis
collapse without warning associated with LOC for few seconds
typically complete (3degree) heart block on ECG during attack

not used so much anymore as is a clinical diagnosis and improvement in understanding of CVS means there is a move away from clinical diagnoses

Question 21

what is stokes adams usually associated with

Answer 21

IHD

Question 22

classic px of stokes adams

Answer 22

collapse usually without worning
LOC for few seconds
characteristic: paleness prior, flushing on recovery

Question 23

causes of narrow complex tachycardia

Answer 23

sinus tachy
SVT
AF
atrial flutter
atrial tachy (rare, digoxin)
junctional tachy
WPW syndrome

Question 24

never use the word dizzy! how to be more specific?

Answer 24

lightheaded - cardiac (sudden fall in BP)
“feel like on a boat” -> cerebellar
world moving around me -> vertigo

Question 25

what is torsades de pointes and what is it due to

Answer 25

aka polymorphic VT (in VT, the QRS can be monomorphic (all look the same) or polymorphic (look different each time). polymorphic VT is aka to) looks like VF but is VT with varying axis due to increased QT interval

Question 26

what arrhythmia can prolonged QT interval lead to

Answer 26

torsade de pointes

Question 27

rx torsades de pointes

Answer 27

mgso4

Question 28

causes of long QT syndrome

Answer 28

``` inherited hypokal or hypocal HF drugs -antipsychotics (haloperidol) -antiarrhythmics! (amiodaronem sotalol) -antibiotics (cipro, clarithro, erythro -antideprssants (amitriptyline, fluoxetine, sertaline, venlafaxine) ```

Question 29

symptoms of long QT

Answer 29

``` often asymptomatic syncope (if get temporary torsades de pointes) sudden death (if have prolonged torsades de pointes) ```

Question 30

what is brugada syndome

Answer 30

genetic | problem with sodium channel

Question 31

symptoms of brugada

Answer 31

many asympomaic may be triggered by fever syncope sudden cardiac death (often in young) if rhythm does no resolve

Question 32

what are people with brugada prone to

Answer 32

VF and VT

Question 33

characteristic pattern of brugada on ECG

Answer 33

ST elevation in V1-V3 T inversion may be sadleback apearance of S in V1 may be there all the time or in response to triggers: drugs, fever, exercise

Question 34

treatment of brugada

Answer 34

ICD (implantable cardioverter defibrillator)

Question 35

what ix can be done if suspected arrhythmia but not captured on ECG or 24 hour ECG

Answer 35

implantable loop recorder (measures heart rhythm for up to 3 years. records whenever it sees something funny)

Question 36

when is a cannonball pulse seen

Answer 36

complete heart block - atria and ventricles contract at the same time and bounce off each other. blood flows out of atria, back up vena cava. looks like a raised JVP but is only there some of the time.