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Arrhythmias Flashcards

Atrial fibrillation Atrial Flutter WPW Brugada Heart block SVT Ventricular tachycardia Ventricular fibrillation Prolonged QT (67 cards)

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1
Q

what is atrial fibrillation?

A

chaotic irregular atrial rhythm

AVN responds intermittently so there is irregular ventricular rate

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2
Q

What does AF increase the risk of?

A

embolic strokes

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3
Q

What are the causes of AF?

A
  • HF/ischaemia
  • HTN
  • MI
  • PE
  • mitral valve disease
  • Pneumonia
  • Hyperthyroidism
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4
Q

What are the sx of AF

A

Palpitations, SOB, chest pain, faintness, asymptomatic

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5
Q

What is the one main sign of AF

A

irregularly irregular pulse

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6
Q

What can be found on ECG in AF

A

absent p waves

irregular QRS complexes

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7
Q

What are the 3 main types of AF?

A
  1. paroxysmal - 2 or more episodes that self-terminate (<7 days)
  2. persistent - episodes that don’t self-terminate (>7 days)
  3. permanent - continuous AF that can’t be cardioverted (chronic)
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8
Q

Give the management of acute AF

A
  1. O2, U+E, emergency cardioversion
  2. Rx associated illness e.g. MI
  3. Control ventricular rate: diltiazem, verapamil, metoprolol
  4. start full anticoagulation w LMWH
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9
Q

What are the two main options for treatment of AF

A
  1. RATE control - BB or CCB (diltiazem)+ digoxin if needed

2. Rhythm control - cardio version, get the pt into and maintain normal sinus rhythm

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10
Q

When can a patient not be cardioverted and why?

A

if they have had sx for more than 48hrs or aren’t on anticoagulants as the moment a pt switches from AF to sinus rhythm is the highest risk of embolism

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11
Q

What is the management of AF w onset under 48hrs

A

Heparinise
Those w RF s for ischaemic stroke - lifelong anticoagulation
Cardioversion

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12
Q

What are the types of cardio version? when are they used?

A
  1. electrical cardioversion ‘DC’

2. pharmacological - amiodarone if structural HD (most elderly ppl), flecainide if not

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13
Q

What is the management of AF >48rs

A

Anticoagulation for at least 3 weeks prior to cardio version
Electrical cv recommended
Anticoagulate for 4 weeks

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14
Q

What is atrial flutter

A

form of SVT where there is succession of rapid atrial depolarisation waves

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15
Q

How does atrial flutter appear on ECG?

A

Sawtooth pattern

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16
Q

What is the treatment of atrial flutter?

A

similar to AF but is more sensitive to electrical CV and requires lower energy levels
Cure is radio frequency ablation of tricuspid valve isthmus

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17
Q

What is 1st degree HB

A

PR interval is >0.2s

always generates a QRS

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18
Q

What are the sx and rx of 1st degree HB

A

usually asymptomatic, no Rx needed

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19
Q

What are the different types of 2nd degree heart block?§

A

1st (wenkebach) - progressive prolongation of PR interval until QRS is dropped
2nd PR interval constant but P wave often not followed by QRS complex

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20
Q

What is 3rd degree hb?

A

complete HB, no association between p waves and QRS c

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21
Q

What is the management of 2nd and 3rd degree heart blocks?

A

type 1 - none unless symptomatic, atropine IV or temp pacemaker
type 2 - permanent pacemaker
3rd degree - permanent pacemaker unless cause is reversible

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22
Q

What is Wolff Parkinson white?

A

congenital accessory conducting pathway (bundle of Kent) between atria and ventricles causing atrioventricular re-entry tachycardia (paroxysmal SVT)

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23
Q

Why is WPW dangerous?

A

episodes of AF or an abnormal heart rhythm can degenerate to VF as the accessory pathway doesn’t have the rate slowing properties of the AV node

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24
Q

What are the symptoms in WPW

A

palpitations, SOB, lightheadedness and syncope

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25
What findings can be found on ECG in WPW?
``` In normal sinus rhythm: short PR interval Wide QRS Delta waves - slurred upstroke of QRS Right axis deviation (if L sided accessory pathway) During a re-entry tachycardia: no p waves tachycardia Often indistinguishable from other forms of SVT ```
26
What is the treatment for: I) stable WPW ii) unstable WPW
``` Stable: Procainamide if wide QRS Adenosine or CCB if narrow QRS Unstable: Electrical CV Long term definitive therapy: radio frequency catheter ablation ```
27
What is the inheritance pattern of Brugada syndrome?
autosomal dominant | mutation of SCN5A gene - encodes myocardial sodium ion channel protein
28
In what group of people is Brugada syndrome more common?
asian
29
Why is brugada syndrome dangerous?
can cause fainting or sudden cardiac death due to serious abnormal heart rhythms e.g. VF or polymorphic ventricular tachycardia
30
What ECG changes can be seen in Brugada syndrome
Convex ST segment elevation >2mm in >1 of V1-3 followed by negative T wave Partial RBBB appearance
31
what is the treatment of Brugada syndrome?
implantable cardioverter defibrillator
32
What can cause 3rd degree heart block?
``` Coronary ischaemia - most common: - Inferior wall MI - damage resolves - Anterior wall mI - extensive permanent damage Hyperkalaemia Congenital - lupus ```
33
How does atropine work?
reduces vagal stimulation through the AV node
34
What is supraventricular tachycardia?
sudden onset of narrow complex tachycardia
35
How is SVT different to ST?
``` SVT: begins abruptly HR: 160-240 Terminated by vagal manoeuvre ST: Begins more slowly Rate <160 Not terminated by vagal manoeuvre ```
36
What is the management of paroxysmal SVT?
Acute: vagal manoeuvres e.g. valsalva, carotid sinus massage (differentiates between tachy of ventricular origin) IV adenosine: 6mg ->12mg Electrical CV
37
How are episodes of PSVT prevented?
beta blockers | radio frequency ablation
38
What is an alternative for adenosine?
verapamil
39
When is carotid sinus massage CI and why?
in elderly due to risk of stroke in those w atherosclerotic plaques in carotid arteries
40
how do vagal manoeuvres work?
increase the resistance of the AV node to transmit impulses through the activation of the parasympathetic nervous system conducted to the heart by th vagus nerve
41
How does adenosine work?
increases atrioventricular (AV) node refractoriness
42
What SVTs does adenosine not work and why?
atrial flutter and AF as they don't involve the AV node
43
In who should adenosine not be given to and why?
Those who will not tolerate its transient bradycardic effects e.g. hypotension, coronary ischaemia, decompensated HF asthma or COPD due to bronchospasm
44
What can cause ectopic beats?
post MI or normal healthy adults
45
When are those with ectopic beats at risk of VF?
if no gap before T wave
46
What is the treatment of ectopics?
iv amiodarone or just observe
47
Why is VT dangerous?
can turn into VF
48
What can be seen on ECG in VT?
Broad QRS No p waves T waves difficult to identify Regular QRS w rate ~200bpm
49
what can cause VT
``` Commonly: Coronary heart disease heart failure cardiomyopathy valvular disease Less commonly: Brugada long QT prinzmetals angina sarcoidosis ```
50
What are the two main types of VT
monomorphic - commonly due to MI | Polymorphic - e.g. torsades de pointer caused by prolonged QT interval
51
What is the treatment of VT
If haemodynamically unstable (adverse signs SBP<90, chest pain, HF): immediate cardioversion If stable: amiodarone (central line ideally) IV w dextrose or lidocaine or procainamide if drugs fail, electrical CV
52
What drug should not be used in VT and why?
verapamil as can precipitate cardiac arrest
53
When should lidocaine be used with caution in vt?
in those w severe LV impairment
54
How can further VTs be prevented?
surgical isoplation of arrhythmogenic area or implantable cardioverter defibrillator (indicated if severe lv function)
55
What is the treatment of VF?
asynchronised DC shock
56
What is a capture beat?
when the SA node captures ventricles in midst of AV dissociation to produce a normal QRS complex
57
What is a fusion beat
supra ventricular + ventricular pulse coincide to produce hybrid complex
58
What are the congenital causes of prolonged QT
Jervell-Lange-Nielsen syndrome (inc deafness) | Romano-Ward syndrome
59
What drugs cause long QT syndrome
``` Class 1a anti-arrhythmic drugs e.g. amiodarone, sotalol TCAs, SSRIs Methadone Chloroquine Erythromycin Haloperidol Ondansetron ```
60
What are other causes of long QT syndrome
``` Electrolyte imbalances: - hypocalcaemia - hypokalaemia - hypomagnesaemia Acute MI Myocarditis Hypothermia SAH ```
61
What is the management of long QT syndrome?
avoid precipitants beta blocker implantable cardioverter defibrillator
62
When does bradycardia require treatment?
1. signs of haemodynamic compromise: - shock - hypotension, pallor, cold extremities, clammy, confusion, impaired consciousness - syncope - Myocardial ischaemia - HF 2. Risk of asystole
63
what is the treatment for bradycardia peri-arrest
atropine 500mcg IV (max 300mg) transcutaneous pacing isoprenaline/adrenaline titrated IV
64
What are risk factors for asystole in Bradycardia
- complete HB w broad complex QRS - Recent asystole - Mobitz type II AV block - Ventricular pause >3 seconds
65
What is the treatment of torsades de pointes?
IV magnesium sulphate
66
What is the normal QTC n men and women ?
<430 in males | <450 in females
67
In long QT syndrome, when are implantable cardiodefibrillators required as treatment?
QTc >500 or prev cardiac arrest

Cardiology (13 decks)

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