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CVS Pathologies - Summary > Arrythmias > Flashcards

Arrythmias Flashcards

1
Q

Presentation of arrhythmias

A 
Asymptomatic
Palpitations
Dyspnoea
Chest pain
Fatigue
Embolism
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2
Q

Investigations for arrhythmias

A

12 lead ECG (24 hours)
Blood test (esp. thyroid function)
ECHO

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3
Q

Therapeutic options for arrhythmias

A

Rate control vs. Rhythm control

  1. Digoxin/Beta-blocker/Ca-antagonist PLUS warfarin (or aspirin if low risk)
  2. Electrical Approaches occasionally
    - Pace and ablation of AV node
    - Substrate modification e.g. pulmonary vein ostial ablation, maze procedures
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4
Q

Types of arrthymias

A
  1. Sinus arrhythmias
  2. Supraventricular Arrhythmias
    - Atrial fibrillation
    - Supraventricular tachycardia
  3. Ventricular arrhythmia
    - Ventricular tachycardia
    - Ventricular fibrillation
  4. Heart block
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5
Q

A normal sinus rhythm ECG

A 
Rhythm: regular
Rate: 60-99bpm
QRS duration: normal
P wave: visible before each QRS complex
P-R interval: normal (<5 small squares)
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6
Q

1st degree heart block on ECG

A

Prolonged P-R interval

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7
Q

2nd degree heart block on ECG

A 
Mobitz Type 1:
- Progressive PR prolongation until a P wave (e.g. 6th) fails to conduct through the ventricle
Mobitz Type 2:
- P wave ratio 2:1, 3:1
- QRS duration prolonged
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8
Q

3rd degree heart block on ECG

A

Complete heart block

  • Rate = slow
  • P wave = constant but bear no relation to QRS complex or ventricular activity
  • P-R interval = variation
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9
Q

Atrial Flutter Treatment

A

Control ventricular rate and thromboembolic risk
Usually cardiovert
Prevent with AA drugs or RFA of cavotricuspidsthmus

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10
Q

Atrial Flutter on an ECG

A

P waves replaced with multiple F (flutter waves) usually at a ratio at 2:1 (2F:1QRS) but sometimes 3:1
High heart rate
P-R interval not measurable

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11
Q

Atrial Fibrillation on an ECG

A

Rhythm: irregularly irregular
Rate usually high but slower if on medication
P wave not distinguishable
P-R interval not measurable

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12
Q

Supraventricular tachycardia types

A

AV-nodal re-entrant tachycardia

AV re-entrant tachycardia (due to accessory pathway - WPW if overt)

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13
Q

Supraventricular tachycardia on an ECG

A

High heart rate
P Wave often buried in preceding T wave
P-R interval depends on site of supraventricular pacemaker

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14
Q

Symptoms of Wolff-Parkinson White syndrome

A 
Palpitations
Syncope
SOB
Chest pain
Sweating
Anxious
Finding physical activity exhausting
Fainting
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15
Q

Ventricular fibrillation on an ECG

A

Rate over 300bpm, disorganised
Rhythm is irregular
P wave not seen
DEFIBRILLATE

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16
Q

Ventricular tachycardia on an ECG

A

Rate high
QRS duration prolonged
P wave not seen

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17
Q

Indications for ICD therapy

A

Secondary prevention

  • Cardiac arrest due to VF/VT not due to transient or reversible cause e.g. early phase of acute MI
  • Sustained VT causing syncope or significant compromise
  • Sustained VT with poor LV function
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18
Q

Causes of sinus bradycardia

A

Healthy athletic person = may be normal
Drug abuse
Hypoglycaemia
Brain injury with increased intracranial pressure

19
Q

Causes of sinus tachycardia

A

Stress
Fright
Illness
Exercise

20
Q

Symptoms of AF

A 
Palpitations
Fatigue
Poor exercise tolerance
Presyncope or syncope
Generalised weakness, dizziness, fatigue
21
Q

Goals of treatment for AF

A

Maintain sinus rhythm
Avoid risks of complications e.g. stroke
Minimise symptoms

22
Q

Treatment for AF

A

Warfarin for patients at high risk of complications e.g. stroke
Clopidogrel
Antiarrhythmic drugs

23
Q

Unstable patients requiring immediate DC cardioversion in AF include…

A

Patients with decompensated congestive heart failure
Patients with hypotension
Patients with uncontrolled angina/ischaemia

24
Q

Indications for a pacemaker

A

Temporary
- Intermittent or sustained symptomatic bradycardia, particularly syncope
- Prophylactic when patient high risk for development of severe bradycardia (e.g. 2nd/3rd degree heart block, post anterior MI, even when asymptomatic)
Permeant
- Symptomatic or profound 2nd/3rd degree heart block particularly when cause unlikely to disappear
- Probably Mobitz type II 2nd degree/3rd degree AV block even if asymptomatic
- AV block associated with neuromuscular diseases
- After (or in preparation for) an AV node ablation
- Alternating RBBB/LBBB
- Syncope when bifascular/trifascular block and no other explanation
- Sinus node disease associated with symptoms
- Carotid sinus hypertension/malignant vasovagal syncope

25
Q

Vaughan-Williams Classification of drugs used to treat arrthymias

A 
Class I (1a, 1b, 1c)
Class II
Class III
Class IV
Other
26
Q

Class I antiarrhytmic drugs

A

Membrane stabilising agents

Fast Na Channel blockers

27
Q

Class Ia drugs

A

Quinide
Increase action potential duration
Used for AF, Premature atrial contractions, premature ventricular contractions, ventricular tachycardia, WPW syndrome

28
Q

Class Ib drugs

A

Lidocaine
Accelerate repolarisation and decrease action potential duration
Used for ventricular dysrhythmias only

29
Q

Class Ic drugs

A

Propafenone
Block Na channels with a more pronounced effect
Little effects on AP or repolarisation
Use for severe ventricular dysrhythmias and possible AF/flutter

30
Q

Class II

A 
Beta blockers
Atenolol e.g.
Reduce/block sympathetic nervous system
Supraventricular and ventricular dysrhythmias 
First line for AF (Bisoprolol)
31
Q

Class III

A

Increase action potential duration
Block K channels
Amoidarone
Used for difficult to treat arrhythmias

32
Q

Class IV

A

Verapamil
Calcium channel blockers
Used for paroxysmal SVT, rate control for AF and flutter

33
Q

Digoxin

A

Cardiac glycoside
Inhibits Na/K ATPase pump
Improves strength of cardiac contraction (positive inotrope)

34
Q

Adenosine

A

Slows conduction through AV node
Used to convert paroxysmal SVT to sinus rhythm
Only administered as fast IV push

35
Q

Digoxin toxicity signs

A

Vision changes: yellow glow around objects
ECG: changes in T waves, reverse tick of ST segment in lateral leads
Nausea and vomiting
Brady/tachycardia
Arrythmias: VT or VF

36
Q

Treatment for digoxin toxicity

A

Stop digoxin - but long half life

Digibind (digoxin immune antibody)

37
Q

Amoidarone side effects (striking side effects)

A 
Thyroid problems
Pulmonary fibrosis
Slate: grey pigmentation
Coreal deposits
LFT abnormalities
38
Q

Indications for anticoagulation

A

AF - reduce risk of stroke by 80%
DVT/PE
After surgery
Immobilisation (prophylactic)

39
Q

Anticoagulant drugs

A 
Warfarin
Dabigatran
Rivaroxaban
Apixaban
(Edolaban)
40
Q

Monitoring warfarin therapy

A

INR (international normalised ratio)
Actual thromboplastin time/standard thromboplastin time
Normal INR is 1
Therapeutic INR normally 2.5-4

41
Q

Adverse effects of warfarin

A

Bleeding

Teratogenic (chondrosdyplasia)

42
Q

Drug interactions of warfarin

A

Macrolide antibiotics
Antifungals
Anti-epileptics

43
Q

Bleeding risk on warfarin - CHADS2

A 
Congestive Heart failure - 1
Hypertension - 1
Age - >75 years - 1
Diabetes mellitus - 1
Stroke/TIA - 2

CVS Pathologies - Summary (19 decks)

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