Arrhythmias - pathophysiology, presentation & investigation# Flashcards Preview

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Flashcards in Arrhythmias - pathophysiology, presentation & investigation# Deck (10):
1

Features of arrhythmias

- Asymptomatic
- Palpitations, dyspnoea, chest pain, fatigue
- Embolism

2

Investigation of arrhythmias

- Document arrhythmia on ECG: 12 lead, 24 hour recording, event recorder
- Blood tests esp thyroid function
- Echocardiogram

3

Therapeutic approaches for arryhythmias

Rate control versus rhythm control:
- DIgoxin/beta-blocker/Ca-antagonit plus warfarin versus class Ic/III drugs +/- DC cardioversion
- Electrical approaches: pace & ablation of AV node, substrate modification e.g. pulmonary ostial ablation, maze procedures

- Consider anticoagulation: based on the scoring system

4

Features of supraventricular tachycardia

AV-nodal re-entrant tachycardia
- C/O palpitations, dyspnoea, dizziness
- Good prognosis

AV re-entrant tachycardia (due to accessory pathway-WPW if overt):
- Usually good prognosis
- No treatment
- Drugs (so-so) or RFA

5

Treatment for atrial flutter

- Control ventricular rate & thromboembolic risk
- Usually cardiovert
- Prevent with AA drugs or RFA of cavotricuspid isthmus

6

Features of ventricular tachycardia

- Palpitations, CP, dyspnoea, dizziness, syncope
- Usually structural heart disease

- Take bloods, echo, angio etc

7

What is Torsades de Pointes caused by?

Long QT syndrome
- congenital or acquired
- May cause TdP
- Px drugs, pacing or ICD

8

Indications for ICD (implantable cardioverter defibrillator) therapy

Secondary prevention
- Cardiac arrest due to VF/VT not due to transient or reversible cause e.g. early phase of acute MI
- Sustained VT causing syncope or significant compromise
- Sustained VT with poor LV function

9

What are indications for temporary pacing?

- Intermittent or sustained symptomatic bradycardia, particularly syncope.
- Prophylactic when patient at high risk for development of severe bradycardia e.g. 2nd or 3rd degree AV block, postanterior MI, even when asymptomatic

10

Indications for permanent pacing

- Symptomatic or profound 2nd/3rd degree AV block, particularly when cause unlikely to disappear
- Probably Mobitz type II 2nd/3rd degree AV block even if asymptomatic
- AV block associated with neuromuscular diseases
- After (or in preparation for) AV-nodeablation
- Alternating RBBB/LBBB
- Syncope when bifascicular/trifascicular block and no other explanation
- Sinus node disease associated with symptoms
- Carotid sinus hypersensitivity/malignant vasovagal syncope