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Arrythmias Flashcards

(41 cards)

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1
Q

What is the first line management for unstable tachycardias?

A

Synchronised DC shocks

Peri arrest, hypotension regardless of broad complex, narrow complex or atrial fibrillation

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2
Q

What’s the treatment for stable patient with a broad complex tachycardia with a regular rhythm?

A

Loading dose amiodarone followed by 24 hour infusion. (Lidocaine and procainamide are also options)

Regular BCT - Assume ventricular tachycardia unless previously confirmed SVT with bundle branch block.

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3
Q

What’s the management of a stable, broad complex tachycardia with an irregular rhythm?

A

1) AF with BBB - treat as narrow complex tachycardia

2) polymorphic VT (e.g. Torsade de pointe) - IV magnesium

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4
Q

What’s the management of a stable, narrow complex tachycardia with an irregular rhythm?

A

Probably AF

1) onset <48 hours electrical or chemical cardioversion
2) >48 anticoagulation and rate control eg B-blocker or digoxin

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5
Q

In which patients should you be wary of when prescribing either B-blockers, flecanide or digoxin?

A

BB - asthmatics
Flecanide - structural heart problems
Digoxin - renal problems

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6
Q

What’s the management of a stable, narrow complex tachycardia with a regular rhythm?

A

Vagal manoeuvres followed by IV adenosine

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7
Q

In the management of narrow complex tachycardia with regular rhythms, what dose of adenosine do you give?

A

Initially 6mg, followed by 12mg, followed by another 12mg

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8
Q

Whats a long QT interval and what can it lead to?

A

> 430(males) and >450(females)

Causes delayed depolarisation of the ventricals and can lead to VT, sudden collapse or death.

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9
Q

Causes of a long QT interval?

A

Congenital - Jerrell-Lange-Nielsen syndrome(inc. deafness). Romano-ward syndrome. (No deafness)

Drugs - amiodarone, sotalol, class 1a antiarrthymic drugs, TCA, SSRIS, haloperidone, erythromycin, methadone,

Other - electrolytes, ⬇️K+,⬇️ca2+ ⬇️mg2+, acute MI, myocarditis, hypothermia, Subarachnoid haemorrhage

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10
Q

Signs indicating unstable/ peri-arrest arrthymias

A

Shock (hypotension <90), pallor, sweating, cold, clammy,confusoin)
Syncope
Myocardial ischaemia
Heart failure

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11
Q

What’s used for pharmacological cardioversion of AF?

A

Flecanide or amiodarone

Not flecanide in structural or ischemic heart disease.

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12
Q

What are the main 2 types of VT?

A

Monomorphic- caused by MI

Polymorphic - Long QT precipitates torsades de pointes

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13
Q

What are the main electrolytes causing VT?

A

Hypokalamia

Hypomagnesiumia

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14
Q

Which AF patients would you NOT cardiovert (rhythm control)?

A

Those with AF over 48 hours, as clot will likely to have formed and this can cause a stroke.

Need anticoagulant first.

Generally older people over 65 have rate control. Eg BB or CCB

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15
Q

What does CHA2DS2VAS stand for?

A 
Congestive heart failure
Hypertension 
Age >75 (2)
Age 65-74 (1)
Diabetes
Stroke or TIA (2)
Vascular disease (IHD, PAD) 
Sex (female)
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16
Q

What is bifascicular block on ECG??

A

Combination of RBBB with left anterior or posterior hemiblock. (Left access deviation)

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17
Q

What is trifascicular block on ECG??

Study These Flashcards
A

RBBB, LAD and 1st degree heart block

18
Q

What’s a stokes-Adams attack?

Study These Flashcards
A

Complete heart block (wide QRS) with dizziness and blackouts

Rx permanent pacemaker

19
Q

Causes of right BBB

Study These Flashcards
A

Infarct (inf MI)
Normal variant
Congential (vSD, fallots, ASD)
Hypertrophy (RVH. -PE,Cor pulmonale)

20
Q

Causes of LBBB

Study These Flashcards
A

Infarct inf MI
Coronary heart disease
Fibrosis
LVH - AS, HTN

21
Q

What is the intial shock energy (J) in biphasic defibrillation for broad complex tachycardia?

22
Q

What is the intial shock energy (J) in biphasic defibrillation for narrow complex tachycardia?

23
Q

What is the intial shock energy (J) in biphasic defibrillation for atrial fibrillation?

24
Q

What is the intial shock energy (J) in biphasic defibrillation for ventricular arrthymias?

25
Which patients With AF would you favour rhythm control over rate control?
Coexistent heart failure First onset of AF Obvious reversible causes
26
Management of paroxysmal AF?
Pill in the pocket - oral flecanide or propafenone or sotalol And anticoagulate
27
Treatment options for persistent AF with heart failure?
Carvedilol and or digoxin These improve LV function Do not use non- dihydropyridine CCB (negatively inotropic effects)
28
How to differentiate between VT and SVT with BBB?
VT is more likely if: - hx of IHD - qrs >140 - AV dissociation - RS >100 - capture complexs (intermittent normal QRS) - concordance of QRS direction in v1-v6 (all positive or all negative) - monophasic (triphasic in SVT) - q wave in lead V6 (deep S wave in V6) - LAD
29
Causes of VT?
IM QVICK ``` Infarction Myocarditis QT interval long Valve abnormally - mitral prolapse, AS Iatrogenic - digoxin, anti arrthymics, Cardiomyopathy (dilated) K⬇️, mg ⬇️, o2 ⬇️, acidosis ```
30
What's the most common post MI arrthymia?
Ventricular extrasystoles (ectopics) If frequent - consider amiodarone
31
Pacemarker codes?
3 letters at least 1) chamber paced (A,V, D-dual) 2) chamber sensed (A, V, D, O- none) 3) pacemarker response (triggered, inhibited, dual, reverse 4) programmable or multiprogrammable 5) p- pace, s-shocks, d- pace and shocks, o-none
32
Which are the most common pacemarkers used?
VVI
33
What's cardiac resynchronisation therapy?
For people with heart failure - paces biventricular +/- atrial lead May be combined with a defibrillator
34
Which features with bradycardia indicate the need for treatment?
Shock - hypotension, pallor, sweating, cold, clammy. Syncope MI Heart failure Rx- atropine IV
35
What features indicate the need for transvenous pacing with bradycardia?
Potential for asytole - complete heart block with broad QRS - recent asytole - Mobitz 2 - ventricular pause >3 seconds If delay in transvenous: use atropine, transcutaneous pacing, adrenaline infusion
36
Investigation for arrthymias??
12 lead ECG TFT u&E (k+) FBC Normal? Do holter monitoring Holter normal? External loop recorder Implantable loop recorder
37
Management for long QT?
Avoid drugs/precipitants Beta blockers If QT > 500 or cardiac arrests then ICD
38
Post stroke and AF what is the antiplatlet/anticoagulation guidelines?
300mg aspirin for 2 weeks, then life long anti-coagulation (warfarin or DOAC)
39
Treatment for WPW?
Radioablatin Meds: sotalol, amiodarone, flecanide
40
Top three intrinsic causes of AF
HTN, CAD, VDH
41
Top 3 extrinsic causes of AF
``` Thyrotoxicosis Acute infection (eg rheumatic heart disease) Drug and alcohol intoxication ```

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