arrhythmias

Question 1

supraventricular tachycardia

Answer 1

atrial fibrillation
atrial flutter
ectopic atrial tachycardia

Question 2

supraventricular bradycardia

Answer 2

sinus bradycardia

sinus pause

Question 3

ventricular arrhythmias

Answer 3

ventricular ectopics or premature ventricular complexes PVC
ventricular tachycardia VT
ventricular fibrillation VF
asystole

Question 4

atrio-ventricular node arrhythmias

Answer 4

AVN re-entry tachycardia AVNRT
AV reciprocating or AV re-entrant tachycardia AVRT
AV block - 1st, 2nd, 3rd degree

Question 5

clinical causes

Answer 5

abnormal anatomy 
autonomic nervous system 
metabolic 
inflammation 
drugs 
genetic

Question 6

ectopic beats

Answer 6

beats or rhythms that originate in places other than SA node

Question 7

re-entry

Answer 7

requires more than one conduction pathway with different speed of conduction and recovery of excitability

Question 8

symptoms

Answer 8

palpitations 
SOB
dizziness 
syncope 
presyncope 
sudden cardiac death 
angina 
heart failure

Question 9

investigations

Answer 9

ECG 
CXR
echocardiogram 
stress ECG 
24 hour ECG 
event recorder 
electrophysiological study

Question 10

normal sinus arrhythmia

Answer 10

variation in heart rate, due to reflex changes in vagal tone during the resp cycle
inspiration reduces vagal tone and increases heart rate

Question 11

sinus bradycardia

Answer 11

<60 beats/min
physiological athlete
drugs - beta blocker
ischaemia - common in inferior STEMI

Question 12

sinus bradycardia treatment

Answer 12

atropine

pacing if haemodynamic compromise

Question 13

sinus tachycardia

Answer 13

> 100 beats/min
physiological anxiety, fear, hypotension, anaemia
inappropriate drugs

Question 14

sinus tachycardia treatment

Answer 14

underlying cause

beta adrenergic blockers

Question 15

atrial ectopic beats

Answer 15

asymptomatic, palpitation
no treatment
beta adrenergic blockers may help
avoid stimulants

Question 16

regular supraventricular tachycardia

Answer 16

AVN re-entrant tachycardia
AV reciprocating tachycardia/ AV re-entrant tachycardia
ectopic atrial tachycardia

Question 17

regular supraventricular management

Answer 17

acute - increased vagal tone (valsalva, carotid massage), slow conduction in the AVN
chronic - avoid stimulants, electrophysiologic study and radiofrequency ablation, beta blocker, antiarrhythmic drugs

Question 18

causing of heart block

Answer 18

age
acute MI
myocarditis 
infiltrative disease - amyloid
beta adrenergic blockers, CCB
calcific aortic valve surgery 
genetic - Lenergre's disease, myotonic dystrophy

Question 19

first degree AV block

Answer 19

conduction after P wave takes longer
PR interval longer than normal
no treatment

Question 20

second degree block Mobitz 1

Answer 20

progressive lengthening of PR interval

usually vagal in origin

Question 21

second degree block

Mobitz 2

Answer 21

pathological, my progress to third degree
permanent pacemaker indicated
some action potentials fail to make it through the AV node

Question 22

third degree block

Answer 22

complete heart block
no action fro the SA node gets through the AV node
ventricular pacing

Question 23

ventricular ectopics

Answer 23

causes - structural, metabolic, may be marker for inherited cardiac conditions
beta blocker, ablation of focus

Question 24

ventricular tachycardia

Answer 24

life threatening 
coronary artery disease 
previous MI
cardiomyopathy 
inherited/familial arrhythmia syndromes

Question 25

ventricular fibrillation

Answer 25

chaotic ventricular electrical activity which causes the heart to lose the ability to function as a pump defibrillation, cardiopulmonary resuscitation

Question 26

atrial fibrillation

Answer 26

chaotic and disorganised atrial activity irregularly irregular symptomatic or assymptomatic incidence increases with age

Question 27

mechanisms of AF

Answer 27

ectopic foci muscle sleeves in the ostia of the pulmonary veins

Question 28

AF termination

Answer 28

pharmacologic cardioversion with anti-arrhythmic drugs electrical cardioversion by direct current DCCV spontaneous reversion to sinus rhythm

Question 29

paroxysmal AF

Answer 29

lasting less than 48 hours | often recurrent

Question 30

persistent AF

Answer 30

episode of AF longer than 48 hours which can still be cardioverted to NSR unlikely to spontaneously revert to NSR

Question 31

permanent AF

Answer 31

inability of pharmacologic or non-pharmacologic methods to restore NSR

Question 32

AF associated disease/cause

Answer 32

``` hypertension congestive heart failure sick sinus syndrome coronary heart disease obesity thyroid disease familial cardiac valve disease alcohol abuse congenital heart disease cardiac surgery COPD, pneumonia septicaemia pericarditis, tumours vagal cause - high endurance atheletes ```

Question 33

lone (idiopathic) AF

Answer 33

absence of any heart disease and no evidence of ventricular dysfunction could be genetic symptoms - palpitations, pre-syncope, syncope, chest pain, dyspnoea, sweatiness, fatigue

Question 34

AF with slow ventricular rate

Answer 34

may co-exist with periods of fast VR | a pacemaker may be required

Question 35

rate control of AF

Answer 35

digoxin beta blocker verapamil diltiazem

Question 36

rhythm control of AF

Answer 36

``` pharmacological cardioversion direct current cardioversion anti-arrhythmic drugs catheter ablation of atrial focus/pulmonary veins maze procedure ```

Question 37

``` anti-arrhythmic drugs class 1 ```

Answer 37

reducing Na channel current | lignocaine, quinidine, flecainide, propafenone

Question 38

``` anti-arrhythmic drugs class 2 ```

Answer 38

beta adrenergic antagonists | verapamil

Question 39

``` anti-arrhythmic drugs class 3 ```

Answer 39

action potential prolongation | amiodarone, sotalol, dronedarone

Question 40

``` anti-arrhythmic drugs class 4 ```

Answer 40

Ca channel antagonists | verapamil

Question 41

CHA2DS2VASc score

Answer 41

``` congestive heart failure hypertension >75 diabetes mellitus stroke valscular disease 65-74 sex - female ```

Question 42

atrial flutter

Answer 42

``` rapid and regular form of atrial tachycardia usually paroxysmal macro-reentrant circuit may result in thromboembolism saw tooth f wave ```