cardiac arrthmias 4

Question 1

what is the purpose of rhythm control

Answer 1

restore & maintain sinus rhythm

Question 2

what ways can you restore sinus rhythm?

Answer 2

electrical cardioversion- DC
Pharmacological cardioversion-amiodarone
flecainide
propafenone

Question 3

what do you do if the patient has haemodynamic instability?

Answer 3

electrical cardioversion

Question 4

how do you maintain sinus rhythm and prevent cardiac AF?

Answer 4

Pharmacological therapy-β-blocker (other than sotalol)amiodarone, dronedarone flecainide, propafenone
non-pharm therapy :Non-Pharmacological therapy Left atrial catheter ablation –use of radiofrequency or cryoenergy to isolate pulmonary veins or other ectopic foci Surgical ablation –using the COX-Maze procedure

Question 5

how do you control rate?

Answer 5

controlor slowing of the fast ventricular response via AV blockade

Question 6

when is urgent control of ventricular rate needed?

Answer 6

during Paroxysmal & Persistent AF

Question 7

what bb do you not use when managing AF?

Answer 7

sotalol

Question 8

what drug would you give for rate control for heart failure?

Answer 8

β-blocker±Digoxin

Question 9

what drug would you give for rate control for CAD?

Answer 9

β-blockerCalcium Channel Blocker Combination Rx

Question 10

what treatment would give for AF if the patient didn’t have heart failure or CAD

Answer 10

β-blockerCalcium Channel Blocker Digoxin Combination Rx

Question 11

what is an atrial flutter?

Answer 11

rapid, regular (or slightly irregular) & organised rhythm with atrial rate ~250-400/min, usually with 2:1 AV conduction

Question 12

what is the main cause of atrial flutter?

Answer 12

usually due to a macro-reentrant mechanism in the right atrium involving the tricuspid valve annulus

Question 13

what is atrial flutter very responsive to?

Answer 13

DC cardioversion

Question 14

what is 1st line for restoration of sinus rhythm in atrial

Answer 14

RF catheter ablation

Question 15

what is the two types of ventricular arrhythmias?

Answer 15

A wide spectrum of abnormal cardiac rhythms

Sustained Ventricular Arrhythmias

Question 16

what is a ventricular tachyarrhythmias?

Answer 16

apid, regular run of 3 or more consecutive beats that originate from the ventricle
a150-250 beats/mint a rate of >100 beats/min

Question 17

what are the underlying mechanisms for VT?

Answer 17

reentry
triggered activity
enhanced/abnormal automaticity

Question 18

what does acute VT depend on?

Answer 18

depends on degree of haemodynamic compromise, type & duration of arrhythmia

Question 19

what is the most lethal ventricular arrhythmias?

Answer 19

Ventricular Fibrillation

Question 20

how many beats does a VF usually have per minute?

Answer 20

200

Question 21

what is the underlying mechanism for VF?

Answer 21

random/ multiple wavelength reentry

Question 22

what are the potential consequences of VF?

Answer 22

circulatory collapse death or irreversible brain damage

Question 23

what ways do you manage VF?

Answer 23

electrical defibrillation (non-synchronisedcardioversion)
cardiopulmonary resuscitation (CPR)
pharmacological defibrillation amiodarone lidocaine
implantable cardioverter defibrillator (ICD)

Question 24

what is an atrioventricular block?

Answer 24

block of conduction through AV node and/or His-bundle or bundle branches

Question 25

what are the possible causes of atrioventricular block?

Answer 25

functional/pharmacological block of AV nodal Ca channels heightened vagal tone hyperkalaemia organic lesions –degenerative or fibrotic disease

Question 26

what are the features of a first degree block?

Answer 26

prolonged PR interval > 0.2 seach atrial impulse is regularly transmitted to ventricles, but with delayusually due to impaired conduction in AV node

Question 27

what are the features of a second degree block?

Answer 27

intermittent blocked beats some atrial impulses are not transmitted to ventricles block could be in AV node or His-bundle or bundle branch

Question 28

what are the two types of second degree block?

Answer 28

Mobitztype I –progressively lengthening PR interval | Mobitztype II –constant PR interval

Question 29

what is a 3rd degree block?

Answer 29

complete AV or heart block no transmission of atrial impulses to the ventricles emergence of 'escape' or idioventricular rhythm (30-50 bpm)

Question 30

what may a 3rd degree block lead to?

Answer 30

asystolic cardiac arrest | 'Stokes-Adamssyndrome'

Question 31

how do you manage atrioventricular block?

Answer 31

withdraw culprit drug | pacemaker implantation