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YR6: CARDIAC > Arrythmias > Flashcards

Arrythmias Flashcards

1
Q

What are the shockable rhythms?

A

Ventricular fibrilation
Pulseless ventricular tachycardia

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2
Q

What are the non shockable rhythms?

A

Asystole
Pulseless electrical activity

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3
Q

If any adverse signs are present in a patient with tachyarrhythmia, what should be done?

A
  1. Up to 3 synchronised DC shocks (+ sedation if conscious) with continued CPR 30:2 in-between
  2. Amiodarone 300mg IV over 10-20 mins
  3. Repeat synchronised DC shock
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4
Q

List 4 adverse signs indicating a patient with an arrhythmia is unstable

A

Shock: hypotension, pallor, sweating, cold extremities, confusion, impaired consciousness
Syncope
Myocardial ischaemia
Heart failure

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5
Q

When assessing a tachyarrythmia, what should you consider?

A

Wide or Narrow complex?
Regular or Irregular
P waves present? Normal or abnormal?

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6
Q

List 5 causes of narrow complex tachycardia

A

Atrial fibrilation
Atrial flutter
Sinus tachycardia
AV nodal re-entry tachycardia
AV re-entry tachycardia

(SVTs: AF, atrial flutter, AVNRT, AVRT)

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7
Q

List 3 causes of broad complex tachycardia

A

Ventricular tachycardia
Supraventricular tachycardia with aberrancy e.g. BBB
Supraventricular tachycardia with pre-excitation e.g. WPW

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8
Q

What should be assumed about the origin of the tachyarrythmia unless proven otherwise?

A

Narrow: supraventricular tachycardias
Broad: ventricular tachycardias

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9
Q

How can you tell a beat is sinus in origin?

A

Normal p wave
Normal (narrow) QRS

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10
Q

How can you tell a beat is atrial in origin?

A

Abnormal p wave
Normal (narrow) QRS

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11
Q

How can you tell a beat is junctional (AVN) in origin?

A

p wave absent (buried)
or
Abnormal p wave just before/ after QRS
Narrow QRS

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12
Q

How can you tell a beat is ventricular in origin?

A

Wide QRS, abnormal T waves
No p wave

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13
Q

List 3 most common causes of a regular narrow complex tachycardia

A

Sinus tachycardia
Atrial flutter
Re-entrant SVT

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14
Q

List 4 symptoms of SVTs

A

Palpitations
Chest pain
Anxiety
SOB

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15
Q

Describe management of regular narrow complex tachycardia

A
  1. Vagal manœuvre: Valsalva
  2. Adenosine 6mg IV
  3. Adenosine 12mg IV
  4. Adenosine 18mg IV
  5. DC cardioversion (if above fail/ haemodynamically unstable)
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16
Q

What is the valsalva manœuvre?

A

Forced expiration against a closed glottis
Ask patient to try to blow plunger back on 20ml syringe

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17
Q

List 5 side effects of adenosine

A

Nausea
Dizziness
Breathlessness
Chest tightness
Flushing

18
Q

Name 2 drugs that interact with adenosine

A

Dipyridamole (antiplatelet agent): enhances effects of adenosine
Theophylline: blocks effects of adenosine

19
Q

Describe the MOA of adenosine

A

Causes transient heart block in the AV node
Agonist of A1 receptor in AVN, which inhibits adenylyl cyclase; reducing cAMP + causing hyperpolarization by increasing outward K+ flux
V short half-life: 8-10s

20
Q

How should adenosine be administered? Why?

A

Infused via a large-calibre cannula due to it’s short half-life

21
Q

In which patients is adenosine contraindicated? What drug is preferred?

A

Asthmatics (may cause bronchospasm)
Verapamil 5-10mg IV

22
Q

What is the long term management for patients with SVT due to AVNRT?

A

Educate on vagal manoeuvres
B-blockers
Catheter ablation

23
Q

Give 4 ECG features of atrial fibrillation

A

Irregularly irregular rhythm
No p waves
Unstable baseline
Narrow QRS complexes

24
Q

What is the probable cause of an irregular narrow complex tachycardia?

25
Describe acute management of atrial flutter
Similar to AF although medication may be less effective Flutter is more sensitive to cardioversion so lower energy levels may be used
26
Describe long term management for atrial flutter
Radiofrequency ablation of Tricuspid valve isthmus
27
What are the types of ventricular tachycardia?
Monomorphic VT: all QRS complexes about the same size Polymorphic VT (TdP): changing QRS amplitude
28
Give 4 indicators of VT
AV dissociation Fusion beats Capture beats Extreme axis deviation
29
Describe management of Torsades de pointes
Magnesium sulfate 1-2g IV
30
Describe treatment of broad complex tachycardias | In haemodynamically stable patients
1. Amiodarone 300mg IV over 10-60 mins 2. DC Cardioversion
31
Give 2 alternatives to amiodarone in management of broad complex tachycardia
Lidocaine: use with caution in severe LV impairment Procainamide
32
What is the long term management for ventricular tachycardia?
Implantable cardioverter defibrillator +/or B-blockers / Sotalol
33
What is the class and MOA of Amiodarone?
Class III antiarrhythmic agent Blocks K+ channels which inhibits repolarisation + hence prolongs the action potential. Also has other actions such as blocking Na+ channels (a class I effect)
33
What effect does Amiodarone have on the p450 enzyme system?
p450 inhibitor e.g. Decreases metabolism of warfarin
34
Give 2 limiting factors to the way in which amiodarone is administered
V long half-life (20-100 days). For this reason, loading doses are frequently used Ideally given into central veins (causes thrombophlebitis)
35
What ECG changes may be caused by amiodarone?
Lengthens QT (proarrhythmic effect) Bradycardia
36
What are the monitoring requirements for amiodarone?
Prior to Tx: TFT, LFT, U&E, CXR Every 6 months: TFT, LFT
37
What alternative drugs can be given second line in management of bradycardia?
Isoprenaline/ Adrenaline infusion
37
List 8 adverse effects of amiodarone
Thyroid dysfunction: both hypo + hyper-thyroidism Corneal deposits Pulmonary fibrosis/ pneumonitis Liver fibrosis/ hepatitis Peripheral neuropathy, myopathy Photosensitivity 'Slate-grey' appearance Thrombophlebitis + injection site reactions
38
What is the treatment for all patients with bradycardia?
1. Atropine 500mcg IV 2. Atropine 500mcg IV repeat to max 3mg 3. Transcutaneous pacing 4. Transvenous pacing
39
Give 4 risk factors for deterioration of bradycardia to asystole
Complete heart block with broad complex QRS Recent asystole Mobits type II AV block Ventricular pause >3s

YR6: CARDIAC (41 decks)

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