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CVS > Arrhythmias Year 3 > Flashcards

Arrhythmias Year 3 Flashcards

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1
Q

What are shockable rhythms?

A

Ventricular tachycardia
Ventricular fibrillation

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2
Q

What are non shockable rhythms?

A

pulseless electrical activity
Asystole

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3
Q

What is Pulseless electrical activity?

A

All electrical activity except VT/VF without a pulse `

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4
Q

risk factors for asystole

A
  • previous asystole
  • ventricular pauses >3seconds
  • mobitz type 2
  • complete heart block
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5
Q

Management of unstable patients at risk of asystole

A
  • IV 500micrograms atropine (first line)
  • inotropes e.g. adrenaline
  • temporal cardiac pacing
  • permanent implantable pacemaker
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6
Q

Mechanism of action of atropine

A

antimuscarinic
inhibits parasympathetic nervous system > enhances AV node conduction > increases heart rate

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7
Q

Adverse drug reactions of atropine

A

anticholingeric side effects:
- dry mouth
- urinary retention
- constipation
- blurred vision

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8
Q

What is bradycardia?

A

Heart rate <60bpm

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9
Q

What are the types of bradycardia?

A
  • Absolute: <40bpm
  • Relative: when Hr is inappropriately slow for Haemodynamic state of patient
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10
Q

What can sinus node dysfunction cause?

A

Sinus bradycardia
sick sinus syndrome
Sinus arrest
Part of vasovagal syncope

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11
Q

what is sick sinus syndrome?

A
  • encompasses many conditions that cause SAN dysfunction
  • often caused by idiopathic degenerative fibrosis of SAN
  • can cause sinus bradycardia, sinus arrhythmias + prolonged pauses
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12
Q

What can cause sinus bradycardia?

A
  • sinus node dysfunction
  • medication e.g. beta blockers
  • hypothyroidism
  • hypothermia
  • sleep apnoea
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13
Q

First line drug treatment of bradycardia?

A

IV atropine 500mcg

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14
Q

Normal PR interval

A

120-200ms (1 big square)

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15
Q

Normal QRS length

A

Up to 120ms
(3 small squares)

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16
Q

Normal QTc

A

400-440ms or 2 large squares

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17
Q

Types of heart block (AV block)

A
  • first degree: prolonged PR interval >200ms (1 big box)
  • Mobitz type I: progressive lengthening of PR interval followed by dropped QRs
  • Mobitz type II: constant PR interval, random QRS dropped
  • complete/third degree: no relationship between p waves + QRS complexes
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18
Q

What medications can cause heart block?

A

Adenosine
digoxin
opioids
lithium
B blockers
CCBs

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19
Q

what is first degree heart block?

A

prolonged PR interval
>200ms (1 big box)

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20
Q

what is second degree heart block Mobitz type 1?

A

progressively longer PR interval followed by dropped QRS
resets + repeats

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21
Q

what is second degree heart block Mobitz type 2?

A

constant normal PR intervals with random dropped QRS

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22
Q

what is 3:1 block?

A

ratio of 3 p waves to one QRS

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23
Q

what is 2:1 block?

A

ratio of 2 p waves to one QRS

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24
Q

what is complete heart block?

A

no relationship between P waves + QRS complex

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25
What are the narrow complex tachycardias?
QRS <120ms (3 small squares) - sinus tachycardia - SVT - AF - atrial flutter
26
Describe atrial flutter
- narrow spectrum tachycardia (QRS <120ms) - saw tooth pattern on ECG - 2:1 conduction - atrial rate ~ 300bpm
27
features of atrial flutter on ECG
- 300bpm - saw tooth pattern - 2:1 conduction
28
treatment of atrial flutter
rate or rhythm control like in AF
29
what is supraventricular tachycardia?
when abnormal electrical signals from above the ventricles cause tachycardia narrow complex tachycardia QRS <120ms
30
What causes SVT?
- electrical signal re-entering atria from the ventricles - re-entry loop - this causes another ventricular contraction
31
How does SVT present on ECG?
- narrow complex tachycardia <120ms (3 small boxes) - p wave + T wave merge
32
management of SVT
- continuous ECG monitoring Step wise approach if not life threatening: - **vagal manoeuvers** (first line) - rapid bolus of ***adenosine*** (first line drug) - ***verapamil* or B blocker** - **synchronised DC cardioversion** . - if life threatening: **synchronised DC cardioversion under GA + IV *adenosine* if unsuccessful**
33
Describe vagal manoeuvres
- stimulate vagus nerve > increases parasympathetic nervous system - slowing electrical activity of heart - *e.g. valsalva manoeuvre, carotid sinus massage, diving relfex*
34
describe valsalva manoeuvers
- involve increasing intrathoracic pressure - pt blows hard against resistance *e..g blowing into syringe for 10 seconds*
35
describe carotid sinus massage
- massage over the carotid sinus in the neck - stimulates baroreceptors
36
Describe the diving reflex
briefly submerging pt face in cold water
37
mechanism of action of adenosine
slows cardiac conduction through AV node
38
Who should adenosine be avoided in?
- asthmatics - COPD - heart failure - heart block - severe hypotension
39
how should adenosine be administered for SVT management
rapid IV bolus into large proximal cannula first 6mg > 12mg > 18mg
40
what should you warn a patient about before giving adenosine?
it may feel like theyr'e dying or their heart has stopped
41
descibe synchronised DC cardioversion
- electric shock applied to heart to restore normal sinus rhythm - shock synchronised with ventricular contractions at the R wave
42
why is _synchronised_ cardioversion used in patients with a pulse?
to avoid shock during T wave as this can cause VF > cardiac arrest
43
management of paroxysmal SVT
- long term meds *e.g. B blockers, CCBs, amiodarone* - radiofrequency ablation
44
What arrhythmias can radiofrequency ablation permanently resolve?
AF atrial flutter SVT WPW syndrome
45
Describe Wolff Parkinson White syndrome
- caused by extra electrical pathway connecting atria + ventricles (Bundle of Kent) - pre-excitation syndrome
46
ECG changes in Wolff Parkinson White syndrome
- short PR interval <120ms - wide QRS complex >120ms - delta wave - axis deviation
47
Management of WPW syndrome
**radiofrequency ablation** of accessory pathway (definitive treatment)
48
What are Broad complex tachycardias
- tachycardia with wide QRS complex >120ms (3 small boxes) - VT or unclear cause - polymorphic VT *e.g. torsades de pointes* - AF with BBB - SVT with BBB
49
Outline prolonged QT intervals
- QT interval from _start_ of QRS complex to end of T wave - QTc estimates the QT interval if HR was 60 - prolonged QT >440/460ms - represents prolonged repolarisation of myocytes
50
Outline Torsades de pointes
- type of polymorphic ventricular tachycardia - broad complex tachycardia >120ms
51
features of torsades de pointes on ECG
- looks like VT but with appearance that QRS is twisting around baseline - QRS height progressively gets smaller + larger + smaller again
52
treatment of torsades de pointes
correcting underlying cause **IV magnesium** defibrillation
53
What are ventricular ectopics?
premature ventricular beats caused by random electrical discharges outside the atria
54
Features of ventricular ectopics
- irregularly irregular pulse - that goes back to sinus at high HR - feeling of missing a beat or extra beat
55
Appearance of ventricular ectopics on ECG
isolated random abnormal broad QRS complexes on otherwise normal ECG
56
what is bigeminy?
when every other beat is a ventricular ectopic
57
Management of ventricular ectopics
- reassurance + no treatment if otherwise F+W - specialist advice in pts with underlying heart disease, frequent or concerning symptoms, or family history of sudden head - beta blockers to manage symptoms
58
Causes of hyperkalaemia
- AKI - metabolic acidosis - Addison's disease - rhabdomyolysis - high K+ diet - drugs *e.g. ACEi, ARBs, spironolactone, heparin,
59
How does hyperkalaemia appear of ECG
- tall tented T waves - flattned p waves - broad QRS complex >3 small squares - sinusoidal wave pattern
60
Management of hyperkalaemia
- combined insulin dextrose infusion - calcium gluconate - calcium resonium - salbutamol nebs
61
Causes of hypokalaemia
- vomiting - thiazide or loop diuretics - Cushing's syndrome + Conn's syndrome - diarrhoea - magnesium deficiency
62
How does hypokalaemia appear on ECG?
- U waves - small or absent T waves - prolonged PR interval - ST depression
63
If a patient is hypokalaemic + you've giving lots of replacement K+ but K+ is not increasing, what should you do?
check magnesium + manage appropriately
64
Treatment of non-shockable rhythms
- CPR 30:2 - adrenaline 1mg ASAP - repeat adrenaline every 5 mins
65
Treatment of shockable rhythms
- CPR 30:2 - defibrillation - IV adrenaline 1mg once compression have restarted after 3rd shock - repeat adrenaline every 5 mins - IV amiodarone 300mg after 3 shocks - further 150mg after 5 shocks
66
ECG changes in LBBB
WiLLiaM W in V1 M in V6
67
Causes of LBBB
- MI - hypertension - aortic stenosis - cardiomyopathy
68
Management of LBBB
- no treatment if asymptomatic + no other heart problems - drugs to control conditions causing LBB *e.g ACEi for HTN* - pacemaker - cardiac resynchronisation therapy
69
ECG features of RBBB
MaRRoW M in V1 W in V6
70
Causes of RBBB
- increasing age - RV hypertrophy - cor pulmonale - PE - MI
71
Management of RBBB
- no treatment if asymptomatic + no other heart problems - drugs to control conditions causing RBB *e.g ACEi for HTN* - pacemaker - cardiac resynchronisation therapy
72
Causes of left axis deviation
- left anterior hemiblock - LBBB - inferior MI - Wolff Parkinson white syndrome - right sided accessory pathway - hyperkalaemia
73
Causes of right axis deviation
- right ventriuclar hypertrophy - lateral MI - cor pulmonale - PE - WPW syndrome - left sided accessory pathway - normal in infant <1 year old - normal/mild in tall people
74
Left axis deviation on ECG
Positive lead I Negative lead II or III/avF avL most positive lead Thumbs away 👍 👎
75
Right axis deviation on ECG
Negative lead I Positive lead II Thumbs together 👎 👍
76
What is bifascicular block? Appearance of ECG
Combination of RBB with left anteior or posterior hemiblock *RBB + left axis deviation* MaRroW + thumbs away + avL most positive
77
What is trifascicular block? Appearance of ECG
RBBB + left axis deviation + 3rd degree heart block . MaRroW + thumbs away + avL most positive + 3rd degrees heart block

CVS (26 decks)

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