Cardiovascular - Arrhythmias

Question 1

what is atrial flutter?

Answer 1

rapid and regular form of atrial tachycardia

Question 2

risk factors for atrial flutter?

Answer 2

cardiac surgery
valve disease
COPD
asthma
HF
hyperthyroid

Question 3

features of arrythmias?

Answer 3

palpitations
chest pain 
syncope
pre syncope
fatigue
sweating

Question 4

why does atrial flutter occur?

Answer 4

re entrant circuit in the RA (where SA node is located)

Question 5

what does atrial flutter usually progress to?

Answer 5

AF

Question 6

features of an atrial flutter EGC?

Answer 6

saw tooth baseline

tachycardia

Question 7

treatment for atrial flutter?

Answer 7

rhythm: amiodarone or cardioversion

rate: verapamil
bisoprolol
digoxin
amiodarone

Question 8

why does AF occur?

Answer 8

ectopic foci in the pulmonary veins cause re-entry circuits

Question 9

what are the different types of AF?

Answer 9

paroxysmal 48hrs-7days
persistent > this time
permanent (cannot be restored)

Question 10

risk factors for AF?

Answer 10

HT
HF
obesity
thyroid disease
valve disease
congenital heart disease

Question 11

ecg changes for AF?

Answer 11

irregularly irregular
absent p waves
f waves replace instead

Question 12

acute AF treatment?

Answer 12

<48hrs - anticoag and
cardiovert if haem unstable OR

amiodarone (structural disease)
flecanide if not
(rhythm)
rate control (Bb/CCB)

> 48hrs - anticoag for 3 weeks pre cardioversion

Question 13

what drugs can be used for rate control?

Answer 13

verapamil
diltiazem
bisoprolol
digoxin

Question 14

what are people with AF.at high risk of? why?

Answer 14

stroke

blood begins to pool in atria due to irregular contractions

Question 15

what is bradycardia?

Answer 15

HR <60bpm

Question 16

causes of bradycardia?

Answer 16

hypothyroid
physical fitness
infections
raised ICP
hyperkalaemia
hypothermia
increased vagal tone

Question 17

what drugs can cause bradycardia?

Answer 17

Bb
CCB
digoxin
anti arrythmia drugs

Question 18

Ix for bradycardia?

Answer 18

ECG
holter monitoring
find the cause (CT, bloods..)

Question 19

when is bradycardia treated? how?

Answer 19

if rate <40bpm and symptomatic

atropine IV
if no response -> pacing wire
pacemaker for permanent fix

Question 20

what is SVT?

Answer 20

rapid regular rhythm arising from atria or involving SA node

Question 21

what must be excluded before SVT is diagnosed?

Answer 21

AF
atrial flutter
sinus tachycardia

Question 22

what type of tachycardia is SVT?

Answer 22

regular narrow complex

Question 23

what is a junctional rhythm?

Answer 23

impulse starts at AV node not SA

impulse travels to atria and ventricles at same time

Question 24

what is an example of a junctional rhythm?

Answer 24

AV nodal re entry tachycardia

Question 25

what occurs in WPW?

Answer 25

congenital accessory pathway between atria and ventricles ventricles are pre excited

Question 26

what changes occur on an ECG in WPW?

Answer 26

``` broad complex QRS delta wave (slurred upstroke to QRS) ``` can present as SVT

Question 27

changes on an ECG in SVT?

Answer 27

narrow QRS | no p waves (atrial depol)

Question 28

treatment for SVT?

Answer 28

vagal manouvres rhythm: IV adenosine (verapamil if asthmatic) DC cardioversion prevent future episodes: verapamil/atenolol

Question 29

what type of rhythms are broad complex?

Answer 29

ventricular

Question 30

features of VF?

Answer 30

loss of consciousness

Question 31

what is VT associated with?

Answer 31

haemodynamic compromise

Question 32

ECG changes for VT?

Answer 32

regular broad complex tachycardia

Question 33

ECG changes for VF?

Answer 33

no clear waveforms

Question 34

what can cause torsades des pointes? what is it?

Answer 34

type of VT | overuse of antiarrythmic drugs

Question 35

treatment for VF?

Answer 35

3 shocks 1mg adrenaline and 300mg amiodarone repeat CPR and give medications every 3-5 mins (alternating with shocks)

Question 36

treatment for VT?

Answer 36

pulseless: same as VF pulse: cardioversion/amiodarone

Question 37

what long term treatment can be given after VT?

Answer 37

ICD/radiofrequency ablation

Question 38

treatment for torsades des pointes?

Answer 38

IV magnesium sulphate

Question 39

what is heart block?

Answer 39

conduction is blocked through the AV node

Question 40

causes of heart block?

Answer 40

``` age MI myocarditis drugs (Bb, CCB) surgery amyloidosis ```

Question 41

ECG changes of 1st degree heart block?

Answer 41

PR interval prolonged

Question 42

ECG changes of 2nd degree heart block?

Answer 42

Mobitz I: progressive lengthening of PR interval until eventual beat dropped can have a vagal cause Mobits II: ratio of 2:1/3:1 of eventual beat dropped always pathological

Question 43

ECG changes of 3rd degree heart block?

Answer 43

no action potential from SA to AV | no relationship with P and QRS

Question 44

treatment of heart block types?

Answer 44

1: none 2: ventricular pacing for Mobitz II Mobitz I no treatment unless severe 3: ventricular pacing

Question 45

what happens in bundle branch block?

Answer 45

one of the L/R bundle branches is no longer conducting

Question 46

causes of RBBB?

Answer 46

RVH cor pulmonale PE CVD

Question 47

causes of LBBB?

Answer 47

MI HT cardiomyopathy

Question 48

what leads are used to determine BBB?

Answer 48

V1 and V6

Question 49

ECG features of BBB?

Answer 49

``` broad QRS William Morrow (LHS) williaM morroW (RHS) ```

Question 50

treatment for BBB?

Answer 50

pacemaker

Question 51

causes of tachycardia?

Answer 51

hyperthermia hypoxia hypercapnia hypokalaemia

Question 52

causes of narrow complex tachycardias?

Answer 52

AF atrial flutter SVT sinus tachycardia

Question 53

causes of sinus tachycardia?

Answer 53

``` anaemia anxiety pain PE pregnancy drugs (caffeine) ```

Question 54

treatment for sinus tachycardia?

Answer 54

vagal manouvres e.g valsalva

Question 55

treatment for LVH?

Answer 55

optimise BP control

Question 56

who gets rate control in AF? what does this mean?

Answer 56

>65yrs ischaemic heart disease heart disease accepts pulse will be irregular

Question 57

who gets rhythm control in AF? what does this mean?

Answer 57

younger asympt first time hear failure gets them back to sinus

Question 58

in what scenario is digoxin used for rate control in AF?

Answer 58

patient has co existing heart failure

Question 59

what can be used for rhythm control in AF?

Answer 59

sotalol amiodarone flecanide catheter ablation

Question 60

what scoring is used to determine if anticoagulation is needed in AF?

Answer 60

Cha2Ds2VASc

Question 61

after cardioversion, how long should patients be anticoagulated for?

Answer 61

4 weeks