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Cardiology > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Consequences of AF

A

Irregularly irregular ventricular contractions
Tachycardia
Heart failure - poor filling of ventricles during diastole
Risk of stroke

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2
Q

Presentation of AF

A

Often asymptomatic (incidental)

Palpitations
SOB
Syncope (dizziness or fainting)
Symptoms of associated conditions (e.g. stroke, sepsis or thyrotoxicosis)

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3
Q

Two causes for irregularly irregular pulse

A

Atrial fibrillation

Ventricular ectopics

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4
Q

AF on an ECG

A

Absent P waves
Narrow QRS Complex Tachycardia
Irregularly irregular ventricular rhythm

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5
Q

Causes of AF (SMITH)

A 
Sepsis
Mitral Valve Pathology (stenosis or regurgitation)
Ischemic Heart Disease
Thyrotoxicosis
Hypertension
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6
Q

Who does NICE suggest does not receive rate control for their AF?

A 
Patient who has:
Reversible cause for their AF
New onset AF (within the last 48 hours)
AF causing heart failure
Remained symptomatic despite being effectively rate controlled
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7
Q

Options for rate control

A

Beta blocker is first line (e.g. atenolol 50-100mg once daily)
Calcium-channel blocker (e.g. diltiazem) (not preferable in heart failure)
Digoxin (only in sedentary people, needs monitoring and risk of toxicity)

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8
Q

When is rhythm control offered?

A

AF with:

Reversible cause

New onset (<48 hours)

Heart failure

Symptoms despite being effectively rate controlled

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9
Q

Preparation for delayed cardioversion

A

Patient should be anticoagulated for a minimum of 3 weeks prior to cardioversion

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10
Q

First line for pharmacological cardioversion

A 
Flecanide
Amiodarone (the drug of choice in patients with structural heart disease)
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11
Q

Drugs used in long term medical rhythm control

A

Beta blockers
Dronedarone
Amiodarone - useful in patients with heart failure or left ventricular dysfunction

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12
Q

Target INR for AF

A

2-3

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13
Q

DOACs vs warfarin

A

No monitoring is required
No major interaction problems
Equal or slightly better than warfarin at preventing strokes in AF
Equal or slightly less risk of bleeding than warfarin

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14
Q

What is the CHA2DS2-VASc score?

A

Does a patient with AF need anticoagulating?
RF for stroke or TIA
>1 = offer anticoagulation

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15
Q

CHA2DS2-VASc Mnemonic

A 
C – Congestive heart failure
H – Hypertension                                      
A2 – Age >75 (Scores 2)
D – Diabetes
S2 – Stroke or TIA previously (Scores 2)
V – Vascular disease                                 
A – Age 65-74
S – Sex (female)
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16
Q

What is HASBLED?

A

Tool for establishing a patient’s risk of major bleeding whilst on anticoagulation

17
Q

What are the four cardiac arrest rhythms?

A

Ventricular tachycardia
Ventricular fibrillation

Pulseless electrical activity
Asystole

18
Q

How is Atrial flutter treated?

A

Rate control

beta blocker

19
Q

How are Supraventricular tachycardias treated?

A

Vagal manoeuvres

Adenosine

20
Q

Tachycardia treatment in unstable patient

A

Consider up to 3 synchronised shocks

Amiodarone infusion

21
Q

Treatment for VT

A

Amiodarone infusion``

22
Q

Conditions associated with atrial flutter

A

Thyrotoxicosis
Hypertension
Ischaemic heart disease
Cardiomyopathy

23
Q

Treatment for Atrial Flutter (4)

A

Rate/rhythm control with beta blockers or cardioversion
Treat the reversible underlying condition (e.g. hypertension or thyrotoxicosis)
Radiofrequency ablation of the re-entrant rhythm
Anticoagulation based on CHA2DS2VASc score

24
Q

What is SVT caused by?

A

Electrical signal re-entering the atria from the ventricles

25
Q

Acute Management of Stable patients with SVT (6)

A

Continuous ECG monitoring

Valsalva manoeuvre - Blow hard against resistance - plastic syringe

Carotid sinus massage. Massage the carotid on one side gently with two fingers

Adenosine
An alternative to adenosine is verapamil (calcium channel blocker)

Direct current cardioversion may be required if the above treatment fails

26
Q

What does adenosine do?

A

Slows conduction though the AV node

Interrupts the AV node / accessory pathway during SVT and “resets” it back to sinus rhythm

Often causes a brief period of asystole or bradycardia, however it is quickly metabolised and sinus rhythm should return

27
Q

Key points in administering adenosine

A

Avoid if patient has asthma / COPD / heart failure / heart block / severe hypotension

Warn patient about the scary feeling of dying / impending doom

Give as a fast IV bolus into a large proximal cannula

28
Q

What is the long term management of paroxysmal SVT

A

Medication (beta blockers, calcium channel blockers or amiodarone)
Radiofrequency ablation

29
Q

What happens in WPW syndrome?

A

Extra electrical pathway connecting the atria and ventricles
(Bundle of Kent)

Treated with radiofrequency ablation of the accessory pathway

30
Q

ECG changes in WPW syndrome

A

Short PR interval (< 0.12 seconds)
Wide QRS complex (> 0.12 seconds)
“Delta wave” which is a slurred upstroke on the QRS complex

31
Q

Causes of long QT

A

Long QT Syndrome (inherited)

Medications (antipsychotics, citalopram, flecanide, sotalol, amiodarone, macrolide antibiotics)

Electrolyte Disturbance (hypokalaemia, hypomagnesaemia, hypocalcaemia)

32
Q

First degree HB on ECG

A

PR interval greater than 0.20 seconds

33
Q

Wenckebach’s phenomenon (Mobitz Type 1) on ECG

A

Increasing PR interval until the P wave no longer conducts to ventricles

34
Q

Mobitz Type 2 on ECG

A

Usually a set ratio of P waves to QRS complexes

35
Q

Third degree HB

A

Complete heart block

no observable relationship between P waves and QRS complexes

Significant risk of asystole

36
Q

Treatment for unstable bradycardia or AV node block

A

FIRST LINE: Atropine 500mcg IV

Other inotropes (such as noradrenalin)
Transcutaneous cardiac pacing (using a defibrillator)
37
Q

Treatment for bradycardia or AV node block In patients with high risk of asystole (i.e. Mobitz Type 2, complete heart block or previous asystole)

A

Temporary transvenous cardiac pacing

Permanent implantable pacemaker

38
Q

Side effects of atropine

A

antimuscarinic - inhibits the parasympathetic nervous system

pupil dilatation
dry eyes

urinary retention
constipation

Cardiology (6 decks)

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