Arrythmias

Question 1

What is normal sinus rhythm?

Answer 1

60-100bpm

Question 2

What is normal p wave?

Answer 2

0.5-2.5mm tall

Question 3

What is normal PR interval?

Answer 3

0.12-0.2 secs

Question 4

What is normal QRS complex?

Answer 4

<0.12secs

Question 5

What is normal QT interval?

Answer 5

<0.42 secs

Question 6

What is normal T wave?

Answer 6

0.1-0.25 secs

Question 7

What is normal ST segment?

Answer 7

0.08 secs

Question 8

What are the four cardiac arrest rhythms?

Answer 8

Shockable:
- Ventricular tachycardia
- Ventricular fibrillation
Non-shockable:
- Pulseless electrical activity
- Asystole

Question 9

What are the types of tachycardia?

Answer 9

Sinus tachycardia
Supraventricular tachycardia
Wolf Parkinson White syndrome
Atrial flutter
Atrial fibrillation
Ventricular tachycardia
Torsade’s de pointes
Ventricular fibrillation

Question 10

What is SVT?

Answer 10

Electrical signal re-enters the atria from the ventricles
Narrow QRS complex
- AV nodal re-entry: re-entry back through AV node
- AV re-entry: re-entry via accessory pathway (WPW)
- Atrial tachycardia: electrical signal originates in atria somewhere other than SA node

Question 11

What is WPW syndrome?

Answer 11

Caused by accessory pathway connecting atria and ventricles called the Bundle of Kent
Short PR interval
Wide QRS complex
Definitive treatment is radiofrequency ablation

Question 12

What is torsades de pointes?

Answer 12

Polymorphic ventricular tachycardia
Occurs in patients with a prolonged QT interval
Twisting and progressive change in amplitude of the QRS complexes

Question 13

What are the types of heart block?

Answer 13

First degree
Second degree
Third degree
Right bundle branch block
Left bundle branch block

Question 14

What is first degree heart block?

Answer 14

Delayed conduction through AV node
Prolonged PR Interval

Question 15

What is second degree heart block?

Answer 15

Excitation intermittently fails to pass through AV node

Question 16

What are the patterns of second degree heart block?

Answer 16

Mobitz type 1 (Wenckebach’s phenomenon)
Mobitz type 2

Question 17

What is mobitz type 1?

Answer 17

Progressive lengthening of PR interval and eventual failure of conduction of atrial beat then cycle repeats

Question 18

What is mobitz type 2?

Answer 18

Intermittent failure of AV conduction causing missing QRS complexes
Risk of asystole

Question 19

What is 2:1 block?

Answer 19

2 p waves for each QRS complex
Caused by mobitz heart block

Question 20

What is third degree heart block?

Answer 20

Complete heart block
No relationship between P waves and QRS complexes
Significant risk of asystole

Question 21

What is RBBB?

Answer 21

Ventricles depolarise consecutively instead of simultaneously
Wide QRS complexes

Question 22

What is LBBB?

Answer 22

Ventricles depolarise consecutively instead of simultaneously
More influence on ECG

Question 23

What is the classification of treatments?

Answer 23

Vaughan William’s classification
- I: Na+ channel blockers
- II: Beta blockers
- III: K+ channel blockers
- IV: Ca2+ channel blockers
- V: other antiarrhythmics

Question 24

What are Na+ channel blockers?

Answer 24

Ia (moderate)- quinidine
Ib (weak)- lidocaine
Ic (strong)- flecainide

Question 25

What are Beta blockers?

Answer 25

Atenolol Bisoprolol Propranolol First line in AF

Question 26

What are K+ channel blockers?

Answer 26

Amiodarone

Question 27

What are Ca2+ channel blockers?

Answer 27

Verapamil Diltiazem

Question 28

What is the action of digoxin?

Answer 28

Cardiac glycoside Blocks Na+/K+ ATPase pump

Question 29

What is the action of adenosine?

Answer 29

Blocks AV node

Question 30

When are anticoagulants given?

Answer 30

Atrial fibrillation Warfarin

Question 31

What are types of anticoagulants?

Answer 31

Vitamin K antagonists- warfarin Thrombin inhibitors- dabigatran Factor Xa inhibitors- apixaban, edoxaban

Question 32

What is atrial fibrillation?

Answer 32

Contraction of atria is uncoordinated, rapid and irregular Absence of P waves

Question 33

What are the symptoms of AF?

Answer 33

Palpitations SoB Syncope Irregular;y irregular pulse

Question 34

What does AF look like on ECG?

Answer 34

Absent p waves Narrow QRS complex tachycardia Irregularly irregular ventricular rhythm

Question 35

What are the main causes of AF?

Answer 35

Sepsis Mitral valve pathology Ischaemic heart disease Thyrotoxicosis Hypertension

Question 36

What is the principles of treating AF?

Answer 36

Rate control Rhythm control Anticoagulation to prevent stroke

Question 37

What is CHA2DS2VAS score for AF?

Answer 37

AF stroke risk Congestive heart failure Hypertension Age>75 Diabetes Stroke history Vascular disease Age 65-74 Sex (female)