Arrythmia

Question 1

Treatment for bradycardia

Answer 1

firstly identify whether there is a reversible cause of bradycardia. If cardiogenic then manage pharmacologically
1. Atropine
2. Isoprenaline

Question 2

If pharmacological treatment fails for bradycardia, what should you do?

Answer 2

transvenous pacing

Question 3

How many ms is big box on ECG?

Answer 3

0.2 ms

Question 4

Differentials for causes of bradycardia

Answer 4

cardiac in origin- AV block
non cardiac in origin- hypothyroidism, hyperkalaemia, vasovagal, hypothermia
drug-induced- beta blockers, digoxin, amiodarone
physiological- athletes, sleeping etc

Question 5

Symptoms of bradycardia?

Answer 5

fatigue
lightheadedness
pre-syncope/scyncope
cognitive slowing
exercise intolerance
or asymptomatic
exacerbation of preexisting conditions

Question 6

Are you worried about first degree heart block?

Answer 6

can be benign, idiopathic, nothing to worry about most of the time

Question 7

Management for narrow QRS supraventricular tachycardia?

Answer 7

vasovagal manoeuvre
adenosine

Question 8

What would you check immediately after seeing VT on ECG?

Answer 8

Do they have a pulse??? pulseless VT- CPR

Question 9

Doses of adenosine?

Answer 9

6mg initially and then 12mg

Question 10

In which condition would you avoid adenosine?

Answer 10

asthma due to bronchoconstriction

Question 11

If adenosine fails, which other pharmacological treatment could you consider?

Answer 11

verapamil
amiodarone

Question 12

Name two adverse features of tachyarrhythmias?

Answer 12

shock
syncope
ischaemia
heart failure

Question 13

If patient has adverse features of tachyarrhythmia, what would be your management?

Answer 13

sedate and then electrical cardioversion
followed by amiodarone

Question 14

Would you cardiovert septic patient with AF?

Answer 14

no treat reversible cause

Question 15

List two adverse symptoms and signs of SVT episode

Answer 15

heart failure
chest pain
Clinical evidence of low cardiac output- confusion/low GCS, systolic BP <90

Question 16

What are signs of low CO in SVT patient

Answer 16

pallor, sweating, cold, clammy extremities (increased sympathetic activity), impaired consciousness or syncope (reduced cerebral blood flow), and hypotension (e.g. systolic blood pressure <90mmHg).

Question 17

Name two pharmacological agents for initial management of SVT. State their MOA

Answer 17

adenosine- transient heart block in the atrioventricular (AV) node
verapamil- block voltage-dependent calcium channel, decreasing impulse conduction through the AV node

Question 18

If chemical cardioversion is unsuccessful in SVT patient, list three steps to take next

Answer 18

1. Call cardiology reg/senior doctor
2. Sedate
3. DC cardioversion

Question 19

Name two ECG changes in hyperkalaemia

Answer 19

hypertented T waves
widened QRS
Prolonged PR
Bundle branch block

Question 20

Name two abnormal gas findings on venous gas of patient with hyperkalaemia and who has CKD

Answer 20

low bicarb
acidotic (raised H+)
Low PCO2`