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Therapeutics > Arrythmia > Flashcards

Arrythmia Flashcards

1
Q

what is arrhythmia

A

problem with heart rate

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2
Q

what is bradycardia

A

slowed heart rate

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3
Q

what is tachycardia

A

increased heart rate

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4
Q

how can we classify arrhythmia

A

Location of damage

Effect on rate

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5
Q

describe the structure of the heart

A

Structure of the heart

  • left and right atria
  • left and right ventricle

Atria and ventricles split by bicuspid and tricuspid valves

Seperated via septum

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6
Q

describe the conduction of a heart beat

A

Sino atrial node conducts an action potential down to the atrio ventricular node

where there is a sleight delay 0.1s to allow the atria to contract.

This then goes down the bundle of his into the atrioventricular bundle branches down into the perkinje fibers causing the ventricle to contract in unison.

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7
Q

What are the 5 phases of a cardiac action potential

A

0 rapid depolarization

1 initial repolarization

2 plateux

3 repolarization

4 baseline

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8
Q

What does Na+ influx lead to

A

rapid depolarization (phase 0)

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9
Q

what does Ca2+ influx lead to

A

slow depolarization (phase 2)

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10
Q

what does K+ efflux lead to

A

repolarization and hyperpolarization (phase 3)

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11
Q

what is refractory period of the heart

A

time take to evoke another Ap constriction limiting absolute contract rate

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12
Q

what is refractory period dependent on

A

Na+ channels

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13
Q

describe how action potentials in pacemaker cells work

A

action potential threshold higher than in muscles -65 needed

slower upstroke of AP gives slower conduction due to L type voltage dependent calcium channels

resting membrane potential is unstable called the pacemaker potential

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14
Q

what is the rhythm of the heart controlled by

A

autonomic nervous system (ANS)

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15
Q

describe how the ANS acts on the heart to controll heart rate

A

right vagus has acetyl choling acting on M2 receptors

symptathetic noradrenaline acts on beta 1 adrenoceptors

left vagus has acetyl choline acting on m2 receptors

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16
Q

describe the different parts of an electrocardiogram

A

P wave = atrial depolarization

QRS complex = ventricular muscle depolarization

T wave = ventricular repolarization during intraventricular conduction time

PR interval = conduction from atrium to ventricle

QT interval = duration of ventricular action potential

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17
Q

what is heart block

A

damage to the conducting system of heart in total heart block, atria and ventricles beat indepndently the rate is determined by the pacemaker that is distal to the condition block.

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18
Q

how do we treat total heartblock

A

pacemaker devices

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19
Q

what is ectopic pacemaker activity

A

pacemaker activity from areas other than SAN

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20
Q

what are the causes of ectopic pacemaker activity

A

sympathetic activity can promote ectopic activity

ischaemia partial depolarization

delayed after depolarization

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21
Q

what is re entry - arrythmias

A

normally action potential dies out in ventricles as surrounding tissue is still in refractory period

damage can mean APs re-excite areas that refractory period has ended, termed re entry or circus movement

ischaemic damage a common cause can cause arterial and ventricular tachycardia and fibrillation

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22
Q

Describe the cardiac action potential

A

-96 as Na+ moves in depolarization occurs

+52 K+ and Cl- out

Ca2+ in K+ out

K+ out repolarization

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23
Q

what is vaugn williams classification based on

A

electrophysiological properties of drugs

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24
Q

what are the 4 classes of vaugn williams

A

sodium channel blockers

beta blockers

amiodarone like drugs

calcium channel blockers

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25
Q

what do sodium channel blockers do

A

block voltage gated sodium channels phase 0 of the cardiac action potential

26
Q

what are the 3 classes of sodium channel blockers

A

Class la - intermediate kinetics

Class lb - Fast kinetics block open channel during phase 0 reducing max depolarization before next beat

Class Ic - Slow kinetics steady state of block during whole cardiac cycle

27
Q

what is the role of beta blockers

A

block action of adrenlaine/noradrenaline on heart to prevent tachyarrhytmias

28
Q

how do beta blockers work

A

Supress actions of sympathetic nervous system, reducing depolarization in phase 4 of the pacemaker AP

29
Q

what is the overall effect of a beta blocker

A

Slowing heart rate and force of contraction

30
Q

what are the main side effects of a beta blocker

A

hypertension and ischaemic heart disease

31
Q

what was amiordarone like originally based on

A

action of amiordarone however not includes other such as sotalol

32
Q

what does amiordarone like do

A

prolong the cardiac ap increasing the refractory period inhibiting potassium channels involved in phase 3

33
Q

what are the serious potential adverse effects of amiordarone

A

lead to pro arrhythmic effects such by prolonging Q-T interval

34
Q

what do calcium channel blocker do

A

they slow the conduction in the sino atrial and atrio ventricular node where action potential depends on calcium entry which reduces the duration of the plateu of the action potential

35
Q

what effect does the calcium channel blocker have

A

reduces for of heart beat

also reduce after depolarization preventing ectopic beat

36
Q

what do class 1 drugs work on

A

phase - 0

37
Q

what do class 2 drugs work on

A

phase 2 and 4

38
Q

what do class 3 drugs work on

A

phase 3

39
Q

what drug are not classified in vaugn williams system

A

many however one of which is anti arrhytmic drugs

40
Q

what is adenosine used in

A

supraventriculartachycardia (SVT), stops SVT if other measures fail as action are short lived it is safer than verapamil

41
Q

what does digoxin do

A

used in Atrial fibrillation as slows AV conduction by blocking Na/K atpase involved in resetting the pacemaker cell ion balances

42
Q

what non pharmacological treatment options exist for arrhythmias

A

DC cardioversion - electronic paddles which deliver shocks performed under anaesthetic used for SVT and VT if haemodynamically unstable

implantable defibrillator

catheter ablation high power radio waves used to lesion small areas known to be causing tachyarrhythmias

electronic pacemaker

43
Q

what 4 things do we consider when managing arrhythmia

A

eliminate cause
make diagnosis
determine baseline condition
therapy needed?

44
Q

what are the two types of tachyarrhythmias

A

supraventricular SVT

ventricular VT

45
Q

what are some symptoms of SVT

A

palpitations, fainting/light headedness and shortness of breath; sometimes causes peripheral and even pulmonary oedema

46
Q

what is the most common sustained arrhythmia

A

supraventricular artial fibrillation

47
Q

what are the causes of supraventricular atrial fibrillation

A 
hypertension
valvular heart disease
coronary disease
heart failure
hyperthyroidism
pulmonary embolism
lungcancer
48
Q

what is the difference between a normal ecg and one with Atrial fibrilation

A

lack of P wave

49
Q

what are the 3 types of atrial fibrillation

A

paroxysmal afib

persistent afib

permanent afib

50
Q

Describe the nice guideline for atrial fibrillation

A

Confirm diagnosis

do further investigations including risk stratifcation for stroke thromboembolism

if paroxysmal af carry out rythm control if failure carry out rate control

if permanent carry out rate control and if remains symptomatic carry out rythm control

if persistant determine whether rhythm or rate then treat appropriatly

51
Q

what can we use for rate control

A

beta blocker or calcium antagonist

sedentary patients use digoxin

52
Q

what can we use for rhythm control

A

electrical cardioversion
pharmacological cardioversion - Class I
catheter ablation

53
Q

if atrial fibrilation what is assessed

A

CHA2DS2Vasc

54
Q

if CHA2DS2VASc score is greater than 2 in a patient with atrial fibrilation what is recommmended

A

anticoagulant

55
Q

what is HAS-BLED used for

A

determine bleeding risk for use of anticoagulants in AF

56
Q

if hasbled score is greater than 3 what risk is it

A

high risk of bleeding and thus requires additional monitoring

57
Q

what is supraventricular AVNRT / AVRT termed

A

paroxysmal supraventricular tachycadria

58
Q

what does AVNRT stand for

A

atrioventricular nodal re entranct tachycardia

59
Q

what does AVRT

A

atrioventricular re entranct tachycardia

60
Q

what can be used to treat supraventricular AVNRT / AVRT

A

often terminated by non pharmacological means e.g. carotid massage or reflex vagal stim

however can be terminated by adenosine as well

61
Q

what are some causings of ventricular tachyarrhytmias

A

congenital heart disease
drugs that prolong long QT interval
changes in blood pH, ionic balance etc
Ischaemic heart disease

62
Q

how do we treat VT and Vf

A

cardioversion to restore sinus rhythm

sustained VT can be treated with amiodarone class 1c or 1b

non sustained VT can be treated with a beta blocker or sotalol implantable cardioversion, catheter ablation

Therapeutics (50 decks)

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