Arrythmias

Question 1

what are the two types of arrhythmias and what difference is there between them?

Answer 1

supraventricular (origin above the ventricle)

ventricular (origin in the ventricle)

Question 2

name two types of supraventricular arrhythmias

Answer 2

SVT

bradycardia

Question 3

what arrhythmias are SVT’s?

Answer 3

atrial fibrillation
atrial flutter
ectopic atrial tachycardia

Question 4

name four ventricular arrhythmias

Answer 4

premature ventricular complexes (PVC)
ventricular tachycardia
ventricular fibrillation
asystole

Question 5

what is another name for premature ventricular complexes?

Answer 5

ventricular ectopics

Question 6

name three AV node arrhythmias

Answer 6

AVN re-entry tachycardia (AVNRT)

AV re-entrant tachycardia (AVRT)

AV block

Question 7

what are the different types of AV block?

Answer 7

1st-3rd degree

Question 8

what is an ectopic beat?

Answer 8

a beat/rhythm that originates outwith the SA node

Question 9

what two things can cause an ectopic beat?

Answer 9

altered automaticity e.g. in ischaemia

triggered activity e.g. caused by digoxin

Question 10

how does re-entry work to cause an arrhythmia?

Answer 10

has more than one conduction pathway, each with different speeds of conduction

Question 11

name three things that can cause re-entry in the heart

Answer 11

accessory pathway tachycardia (WPW)

previous MI

congenital heart disease

Question 12

what triggers re-entry?

Answer 12

an ectopic beat

Question 13

when does an ectopic rhythm take over the intrinsic, sinus rhythm?

Answer 13

when it becomes faster than sinus rhythm

Question 14

what is triggered activity

Answer 14

when a small depolarisation higher than threshold occurs in phase 3 of the AP causes a sustained train of depolarisations

Question 15

what mechanism underlies digoxin toxicity, torsades de pointes and hypokalaemia?

Answer 15

triggered activity

Question 16

name investigations done for arrythmias

Answer 16

ECG (+ exercise ECG + 24 hour recording)
CXR
ECHO
electrophysiological study

Question 17

what does an ECG look for in arrythmia?

Answer 17

assesses the rhythm

looks for previous MI and pre-excitation

Question 18

what condition does pre-excitation occur in?

Answer 18

wolff parkinson white

Question 19

what is an electrophysiological study for arrythmias?

Answer 19

an arrhythmia is induced to study its mechanism and trace it

Question 20

what effect does inspiration have on heart rate and how?

Answer 20

increases heart rate as it reduces vagal tone

Question 21

what is bradycardia?

Answer 21

heart rate under 60bpm

Question 22

who might have physiological bradycardia?

Answer 22

athletes

Question 23

what drug is used to treat sinus bradycardia?

Answer 23

atropine

Question 24

what is used to treat sinus bradycardia if there is a haemodynamic compromise?

Answer 24

pacemaker

Question 25

what is tachycardia?

Answer 25

heart rate over 100bpm

Question 26

how is sinus tachycardia treated?

Answer 26

treat underlying cause | give beta blockers

Question 27

how are atrial ectopic beats treated?

Answer 27

beta blockers may help | avoid stimulants i.e. coffee and cigarettes

Question 28

what causes AVNRT?

Answer 28

a re-entry circuit within the AVN

Question 29

what makes up acute management of SVT?

Answer 29

increase vagal tone | IV adenosine and IV verapamil

Question 30

what can be done to increase vagal tone?

Answer 30

valsalva manoeuvre | carotid massage

Question 31

what is involved in the management of chronic SVT?

Answer 31

avoid stimulants radiofrequency ablation beta blockers antiarrhythmic drugs

Question 32

name two drugs that can cause heart block

Answer 32

beta blockers | calcium channel blockers

Question 33

what happens in first degree heart block?

Answer 33

the conduction following each P wave takes longer

Question 34

what is different in the ECG of someone with first degree heart block?

Answer 34

longer PR interval than normal

Question 35

what happens in second degree heart block?

Answer 35

intermittent block at the AVN causing dropped beats

Question 36

what are the two types of second degree heart block?

Answer 36

mobitz I | mobitz II

Question 37

what happens in mobitz I heart block?

Answer 37

progressive lengthening of the PR interval, eventually causing a dropped beat

Question 38

what happens in mobitz II heart block?

Answer 38

some action potentials fail to get through the AVN

Question 39

how is mobitz II treated?

Answer 39

permanent ventricular pacing

Question 40

what happens in type 3 heart block?

Answer 40

no action potentials from the SA node get through the AV node

Question 41

how is type 3 heart block treated?

Answer 41

ventricular pacing

Question 42

what are the two types of pacemakers and which is used for AVN disease ?

Answer 42

``` single chamber dual chamber (used for AVN disease) ```

Question 43

how does a single chamber pacemaker work?

Answer 43

paces the RA/R V only

Question 44

how does a dual chamber pacemaker work?

Answer 44

paces the RA + RV maintains AV synchrony

Question 45

how are ventricular ectopics treated?

Answer 45

beta blockers ablation of focus

Question 46

what are the two types of VT?

Answer 46

monomorphic | polymorphic

Question 47

name two inherited arrhythmia syndromes that can cause VT?

Answer 47

long QT | brugada

Question 48

what is ventricular fibrillation?

Answer 48

chaotic ventricular electrical activity which causes the heart to lose the ability to pump

Question 49

how is VF treated?

Answer 49

defibrillation | CPR

Question 50

what is the long term treatment for VF?

Answer 50

implantable cardioverter defibrillators (ICD) VT catheter ablation

Question 51

what is atrial fibrillation?

Answer 51

chaotic and disorganised atrial activity

Question 52

what are the three types of AF?

Answer 52

paroxysmal persistent permanent

Question 53

what is paroxysmal AF?

Answer 53

lasts less than 48 hours often recurrent

Question 54

what is persistent AF?

Answer 54

an episode lasting more than 48 hours, that can be cardioverted to NSR

Question 55

what is permanent AF?

Answer 55

AF where no methods can restore NSR

Question 56

what is the most common sustained arrhythmia?

Answer 56

AF

Question 57

what three ways can AF be terminated?

Answer 57

pharmacological cardioversion DCCV spontaneous reversion to NSR

Question 58

how does AF result in reduced cardiac output?

Answer 58

diastole shortened atrial kick lost

Question 59

what might AF cause, especially if cardiac output is reduced?

Answer 59

congestive heart failure

Question 60

ventricular rates above which value suggest an AV conduction disease?

Answer 60

60bpm

Question 61

what is another name for lone AF?

Answer 61

idiopathic AF

Question 62

what is lone AF?

Answer 62

AF in the absence of heart disease and ventricular dysfunction

Question 63

what is there a risk of in AF in elderly patients?

Answer 63

stroke

Question 64

what rate is commonly seen upon ECG of AF?

Answer 64

over 300bpm

Question 65

describe the rhythm of AF

Answer 65

irregularly irregular

Question 66

what can be seen on ECG of AF?

Answer 66

no P waves

Question 67

what are the two possible goals of AF treatment?

Answer 67

rate control | rhythm control

Question 68

what is atrial flutter?

Answer 68

a rapid and regular form of atrial tachycardia

Question 69

name a class I antiarrhythmic drug

Answer 69

lignocaine

Question 70

name a class II antiarrhythmic drug

Answer 70

propranolol

Question 71

name a class III antiarrhythmic drug

Answer 71

amiodarone

Question 72

name a class IV antiarrhythmic drug

Answer 72

verapamil

Question 73

how does a class I antiarrhythmic work?

Answer 73

reduces sodium channel current

Question 74

how does a class II antiarrhythmic work?

Answer 74

beta adrenergic antagonist

Question 75

how does a class III antiarrhythmic work?

Answer 75

prolongs action potential

Question 76

how does a class IV antiarrhythmic work?

Answer 76

calcium channel antagonists

Question 77

what sustains atrial flutter?

Answer 77

a macro re-entrant circuit in the RA