Cardiac - arrhythmia, AF Flashcards
(59 cards)
1
Q
Arrhythmia
Classification by origin of depolarization
A
2
Q
Arrhythmia
Classification by QRS complex
A
3
Q
Interpret
A
4
Q
Interpret
A
5
Q
Interpret
A
6
Q
Interpret
A
7
Q
Interpret
A
8
Q
Interpret
A
9
Q
Narrow complex tachycardia
Diagnostic flowchart
A
10
Q
Wide complex tachycardia
Diagnostic flowchart
A
11
Q
LBBB vs RBBB
ECG features
A
12
Q
Arrhythmia
First line management
A
13
Q
Anti-arrhythmics
Classes
Example
MoA
Useage
A
14
Q
Stable regular narrow complex tachycardia
Treatment
A
15
Q
Stable wide complex tachycardia
Treatment
A
16
Q
Vagal maneuver
MoA
S/E
C/I
A
17
Q
ATP
MoA
S/E
C/I
A
18
Q
Atrial flutter/ atrial fibrillation
Management
A
19
Q
Outline risk stratification score for thromboembolic risk - CHA2DS2-VASc score
A
20
Q
Sinus tachycardia
Management
A
21
Q
Atrial tachycardia
AVRT
AVNRT
Management
A
22
Q
Multifocal atrial tachycardia
Management
A
23
Q
Wide complex tachycardia: VT, SVT with BBB, unknown type
Treatment
A
24
Q
Bradycardia
Types
A
25
Heart block
ECG findings of 1st, 2nd, 3rd degree heart block
26
Heart block causes
1st and 2nd degree
Acute MI
Ischemic heart disease
Acute rheumatic heart disease
Myocarditis
Hypo-K+
Digoxin toxicity
β-blockers treatment
3rd degree
Acute MI
Aortic stenosis
Fibrosis around bundle of His
LBBB + RBBB
27
RBBB
ECG features
Causes
28
LBBB
ECG features
Causes
29
Left anterior hemi-block
ECG features
30
Bifascicular block
ECG feature
31
Sick sinus syndrome
ECG features
32
Bradycardia
First line management
33
Ventricular fibrillation/ Pulseless VT
Management
34
Pulseless electrical activity
Causes
Management
35
Outline primary CDAB and secondary ABCD surveys for VF, Pulseless VT, PEA, asystole
36
Asystole
Management
37
AF
Classification
38
AF
Causes
39
AF
D/dx
40
AF
Pathogenesis
41
AF
Clinical manifestations
42
AF
Investigation
43
AF
Treatment approaches
44
AF
Rate control drug choices
Target HR control
Pharmacological rate control
Target heart rate control
- Symptomatic: Resting HR < 80 bpm
- Asymptomatic + LVEF > 40%: HR < 110 bpm
- Note that rate-control strategy is not indicated if the AF has a slow HR originally
ABCD medications
- β-blockers >> non-dihydropyridine CCB, digoxin, and amiodarone
45
AF
Rate control drugs
- MoA
- Examples
- Contraindications
46
AF
Non-pharmacological rate control
Indication
47
AF
Anti-arrhythmics - Class Ic
- Examples
- MoA
- C/I
- S/E
48
AF
Anti-arrhythmics - Class III Amiodarone
- MoA
- C/I
- S/E
49
AF
Anti-arrhythmics - Class III Dronedarone
- MoA
- C/I
- S/E
Removal of iodine molecule causes less thyroid and systemic side effects compared to amiodarone, but less effective
Iodine also causes fat binding and increases half life of amiodarone
50
AF
Anti-arrhythmics - Class III Ibutilide, Dofetilide, Sotalol
- MoA
- C/I
- S/E
51
Choice of class III anti-arrhythmics in AF with:
- No heart disease
- Post-MI/ CAD
- Heart failure
- Hypertension with LVH
52
AF
Non-pharmacological rhythm control options
**Direct-current (DC) cardioversion** (Electrical cardioversion)
**Catheter ablation:**
- Indicated in patients with symptomatic paroxysmal/ persistent/ long-standing persistent AF who are refractory or intolerant to ≥ 1 Class I or III anti-arrhythmic drugs
- **radiofrequency ablation (RFA) and cryoballoon (cryothermal) ablation**
- Most common pulmonary vein isolation technique is **circumferential pulmonary vein isolation (PVI)**
- **Anticoagulation is indicated** to prevent thromboembolism around the time of RFA
- Complications include **cardiac tamponade (most common), stroke, TIA or pulmonary vein stenosis**
**Surgical maze procedures (Surgical ablation)**
- Indicated in selected patients undergoing other cardiac surgery e.g. valvular replacement or CABG
- **radiofrequency or cryothermal energy (Cox-Maze IV procedure)**
- create a “maze” of functional myocardium within the atrium
53
Direct-current (DC) cardioversion (Electrical cardioversion)
Indications
Anticoagulant timing
S/E
Indications
o Hemodynamically unstable patients
o Refractory to pharmacological cardioversion
o Rapid control of ventricular rate during AF is required (preferred over pharmacological cardioversion in patients with decompensated HF, ongoing myocardial ischemia, or hypotension)
54
AF
Prevention of thromboembolism
- Indication
- Risk stratification
- Drug choices
Choice of antithrombotic options
Options = Warfarin/ Dabigatran/ Rivaroxaban/ Apixaban
Aspirin + Clopidogrel (Dual anti-platelet therapy) – Less effective
- Indicated in patients who refuse or contraindicated to anticoagulants
Aspirin alone – Even less effective
- Indicated in patients who refuse or contraindicated to anticoagulants
55
AF
Warfarin
- Target INR
- MoA
- Indication
- Contraindicaton
56
AF
Direct anticoagulant
* Drug types
* Indication
* Contraindication
* MoA
57
AF
Thromboembolism prevention
Compare NOAC vs Warfarin
- Efficacy
- Safety
- Advantage of NOAC
- Disadvantage of NOAC
58
AF
Bridging therapy
- Indication
- Drug choice
59
AF
Non-pharmacological prevention
