Arryhthmia Flashcards Preview

S and P- Cardio > Arryhthmia > Flashcards

Flashcards in Arryhthmia Deck (48):
1

Where do heart impulses arise?

SA node

2

What happens after the impulse arises- describe course of impulse?

It spreads across the atria and goes down through the AV node through bundle of His and across the ventricles

3

Where can arrhythmias arise?

Different places- atria, AV node or ventricles

4

What does the P wave show?

Atrial depolarisation in response to SA node triggering

5

What does the PR interval show?

Delay of AV node to allow filling of ventricles

6

What does the QRS complex show?

Depolarisation of ventricles, triggers main pumping contractions.

7

What does the ST segment show?

Beginning of ventricle repolarisation, should be flat

8

What does the T wave show?

Ventricular repolarisation

9

What do you look at when looking at ECGs?

First rate:
Tachycardia>100bpm
Bradycardia<60bpm
How broad QRS complexes are:
Narrow < 120ms
Broad >120ms
Rhythm:
Regular
Irregular

10

What is the first thing you need to do if you have a tachycardic patient?

Determine whether they are stable or unstable

11

What do you do if the patient is unstable with tachycardia?

Electric shock

12

What are the signs of instability?

Reduced conscious level
Chest pain
Systolic BP <90mmHg
Heart failure

13

What do you give if a patient has regular narrow complex tachycardia?

Give adenosine

14

What does adenosine do?

Blocks AV node

15

Where do regular narrow complex tachycardia come from?

Top of heart (supraventricular tachycardia) and if you block the conduction through AV node, you terminate the tachycardia

16

What usually causes irregular narrow complex tachycardia?

Atrial fibrillation

17

What does it mean if it is broad complex tachycardia?

It is coming from the ventricles

18

How do you treat broad complex tachycardia?

Amiodarone or shock them

19

What causes irregularly broad complex tachycardia?

Torsades de pointes

20

What are delta waves?

Slurred upstroke to QRS complex- caused by accessory pathway- extra pathway that the electrical activity can travel down other than AV node and bundle of His

21

What type of tachycardia involves accessory pathway?

AV re-entry tachycardia

22

What are the two most likely causes of regular narrow complex tachycardia?

AV nodal re-entry tachycardia
AV re-entry tachycardia (due to accessory pathway)

23

What are the short term and long term treatment for both types of regular narrow complex tachycardia?

Short-
Adenosine
Long-
AV nodal blocking agents (AVNRT)
Class I anti-arrhythmics (AVRT)
Catheter ablation

24

What is the main cause of irregular narrow complex tachycardia?

Atrial fibrillation

25

How does atrial fibrillation work?

Electricity arises in very disorganised fashion from atria
A lot of these little fibrillations in atria get conducted down through AV node into the ventricles so you tend to get tachycardia

26

What is the treatment of AF dependent on?

Onset

27

What do you do if someone with AF is haemodynamically unstable?

Electrical cardioversion

28

What do you do if someone with AF is haemodynamically stable?

Anti-arrhythmic drugs

29

What do you give if there is an underlying structural heart disease?

Amiodarone

30

What do you give if there is no underlying structural heart disease?

Flecainide
Propafenone
Ibutilide

31

What else do you do after bringing an AF patient back to sinus rhythm?

Anti-coagulate them as AF is a leading cause of stroke

32

What is the CHA2DS2-VASc Score?

A score used to estimate risk of having a stroke of someone in atrial fibrillation
C- Congestive heart failure
H- Hypertension
A- Age
D- Diabetes
S- Systemic emboli or previous stroke
Vasc- Vascular disease

33

At what CHA2DS2-VASc score, should they be anti-coagulated?

>1

34

What is atrial flutter?

Organised rhythm caused by a small circuit that is usually set up in the right atrium. Can conduct down through AV node into ventricles

35

What is the key feature of atrial flutter on ECG?

Saw-tooth pattern

36

How do you treat atrial flutter?

Same way as atrial fibrillation- need to be anti-coagulated and generally tend to use the same drugs

37

What are the criteria for cardioverting patients?

Anticoagulated for >3 weeks
Or they present <48 hours from onset of symptoms
Anyone that is haemodynamically stable and has been in AF for >48 hours has to be anticoagulated before they are cardioverted

38

What forms of rate control drugs are there?

Beta-blockers
Rate limiting CCBs
Digoxin

39

For rhythm control, what would you give to young, healthy patients without any underlying structural heart disease?

Flecainide (sodium channel blocker) or propafenone or sotalol

40

What if sodium channel blockers don't work to control rhythm?

Catheter ablation

41

What is the main treatment for rhythm for patients with underlying structural heart disease?

Amiodarone

42

What drugs are most commonly used for rate control?

Beta-blockers

43

What drugs are most commonly used for rhythm control?

Flecainide
Propafenone
Sotalol

44

How do you treat bradycardia due to 3rd degree heart block?

Firstly give atropine
Then external transcutaneous pacing
Definitive treatment- pacemaker

45

What does it mean if there ST elevation in V1 and V5?

Anterior STEMI (blocked left anterior descending coronary artery)

46

How do you treat STEMI?

Angioplasty

47

What would you give to someone before they go to the cathlab?

Aspirin and clopidogrel

48

What are the main features of NSTEMI?

Huge inverted T waves in V1-V5
Characteristic of a sub-totally occluded LAD