Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Emergency medicine > ECGs/arrhythmias > Flashcards

ECGs/arrhythmias Flashcards

(66 cards)

Start Studying
1
Q

Questions to ask to clarify palpitations?

A

Onset:

  • When and how did it start?
  • Sudden vs gradual onset?
  • Dehydration, fear, food

Character:

  • Fast, slow, or irregular?
  • Did you check your pulse at the time?

Timecourse:

  • Precipitating/relieving factors (exercise is a red flag)
  • Duration
  • Resolution - fast/slow, confusion?
  • Previous episodes/FHx (e.g. sudden death)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Associated symptoms of palpitations

A

Dyspnoea

Syncope -> seizures/witnesses

Dizziness/light-headedness

Chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Differential for irregular fast palpitations

A

Atrial flutter, atrial fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Important PMHx for palpitations

A

Rheumatic fever

Angina/IHD

Previous ECG monitoring/angiograms

Diabetes

HTN

Operations (e.g. CABG)

Thyroid function

Valvular heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Differential for slow palpitations

A

Drug-related bradycardias, ventricular bigeminy, heart block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Differential for regular fast palpitations

A

SVTs:

AVNRT (young women, 70% of SVTs)

AVRT: Assoc w/ WPW syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Differential for ‘missed beats’

A

Atrial, ventricular ectopics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is atrial fibrillation?

A

Irregular atrial rhythm from extranodal depolarisation –> variable conduction through AVN leads to irregular ventricular rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the main risk/complication of AF?

A

Embolic stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes of AF?

A

IHD

Mitral valve disease/rheumatic heart disease

Hypertension

Thyrotoxicosis

Precipitants:

  • Pneumonia/endocarditis
  • PE
  • Caffeine, alcohol, post-op
  • Hypokalaemia/Hypomagnasaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Management of acute AF in unstable patient

A

DC cardioversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Management of acute AF in stable patient within 48h of onset

A

Rate OR rhythm control (DC cardioversion or flecainide)

Give heparin if DC cardioversion delayed

Correct underlying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Management of acute AF in stable patient >48h from onset

A

Rate control only!

Need >3wks anticoagulation before rhythm control (incl. DC cardioversion)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pharmacological rate control in AF

A

Ca channel blockers (non-dihydropiridine, e.g. verapamil/diltiazem not amlodipine)

Beta blockers (e.g. bisoprolol)

Digoxin/amiodarone if evidence of heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Rhythm control for AF

A

Beta blocker

Sotalol

Amiodarone

Flecainide

Electricity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Contraindications for flecainide

A

Structural heart disease (e.g. previous MI)

Ischaemic heart disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Management of chronic AF

A

Anticoagulate with DOAC (e.g. apixaban) or warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Management of atrial flutter

A

Same as atrial fibrillation!

DC cardioversion preferred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Lifestyle risk factors for atrial flutters/arrhythmias

A

Stress

Caffeine

Alcohol

Nicotine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Contraindications of atropine for bradycardia

A

Mobitz Type II/complete heart block (only affects SAN not AVN)

Long Q-T –> increase risk of ectopics –> torsades de pointes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Differential for narrow-complex tachycardia

A

Irregular: AF

Regular:

Atrial flutter, atrial tachycardia

AV nodal reentrant tachycardia (75% of SVTs, younger women)

AV reentrant tachycardia (associated with WPW)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which tachycardia is treated with adenosine

A

AVNRT (adenosine blocks AVN only!)

In atrial flutter re-entrant circuit is in wall of atrium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

ECG features of WPW

A

Short PR interval

Delta wave (slurred upstroke of QRS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Differential of broad-complex tachycardia

A

Ventricular tachycardia (80% of broad-complex tachys, 95% of those w/ pre-existing heart disease)

SVT + WPW/BBB

Assume VT until proven otherwise!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Differentiating VT from SVT + BBB
LAD, regularity, QRS \>160ms --\> Suggest VT
26
What is pre-excited AF?
AF + re-entry circuit (e.g. WPW) --\> Fast + irregular QRS (\>200) --\> predispose to VT/VF
27
Causes of prolonged Q-T syndrome
**Anti-arrhythmic drugs:** e.g. amiodarone, sotalol **Psychiatric drugs:** Tricyclic antidepressants, antipsychotics **Antimicrobial drugs:** macrolides, antimalarials **5 hypos:** Hypothyroid, hypothermia, hypokalaemia, hypocalcaemia, hypomagnasaemia
28
What causes torsades de pointes
QRS ectopic landing on T-wave
29
How do you calculate corrected Q-T interval (should be \<450)
QT/sqrt(RR interval)
30
Prolonged PR interval
First degree heart block
31
Mobitz Type II block
Form of second degree heart block Some P waves not followed by QRS complexes
32
Leads where T-wave inversion is normal
VR III V1-V2 (V3-V4 in black people)
33
Normal septal Q waves
I, VL, V6 \<1x2mm
34
Causes of LBBB
MI Myocardial fibrosis: HTN/AS/HCM --\> LV hypertrophy
35
Peaked P waves
P ***P***ulmonale RA hypertrophy: Tricuspid stenosis, pulmonary HTN
36
Bifid P waves
M-shaped --\> P **m**itrale LA hypertrophy (mitral stenosis)
37
ECG changes RV hypertrophy
Dominant R wave in V1, deep S wave in V6 RAD Peaked P waves ?T-wave inversion in V1-V2
38
Posterior MI
Dominant R wave ST depression Upright T waves in V1-V3
39
T-wave inversion differential
STEMI (if Q waves or ST changes) NSTEMI: no Q-waves/ST changes LV hypertrophy/LBBB: Aortic stenosis, HTN RV hypertrophy: Pulmonary HTN Digoxin treatment (reverse tick) Hypertrophic cardiomyopathy (young patients)
40
ECG effects of hypokalaemia/hypomagnasaemia
Flattened T wave Presence of U wave Prolonged PR interval Increased P-wave amplitude
41
ECG effects of hyperkalaemia/hypermagnasaemia
Peaked T waves Prolonged PR interval Flattened P waves Broad QRS complexes
42
Symmetric T-wave inversion in non-coronary distribution
HOCM
43
Causes of raised troponin
MI Myocarditis SVT HF PE Renal failure severe sepsis
44
Mechanisms of bradyarrhythmias
Reduced automaticity (sick sinus syndrome) Reduced condution (heart blocks, SAN/AVN)
45
Mechanisms of tachyarrhythmias
**_Conduction - reentry:_** AVNRT (aka SVT) AVRT (aka WPW) Atrial lutter **_Automaticity:_** Junctional/atrial/ventricular ectopics Atrial fibrillation
46
Atrial flutter ECG
P-wave sawtooth (approx 300bpm) 2:1 or 4:1 block --\> 75 or 150 ventricular rate Narrow-complex Adenosine makes sawtooth pattern more visible
47
Presentation of sick sinus syndrome
**Symptoms:** Lightheadedness, syncope, angina, palpitations **ECG:** Sinus arrhythmia, sinus bradycardia, sinus arrest/pause
48
Aetiology of sick sinus syndrome
**Age-related:** Atherosclerosis of SAN, fibrosis **Inf/inflamm:** Pericarditis, Lyme, RF
49
ECG of Brugada syndrome
Coved ST elevation with downsloping ST segment + T-wave inversion RBBB
50
ECG of torsade de pointes
Sinusoidal cycling of QRS axis and amplitude Self-limiting or progress to VF Occus in patients with hypomagnasaemia/hypokalaemia + Q-T prolongation
51
Adverse features of tachycardia
Syncope Shock MI (incl. just chest pain!!) Heart failure Indications for DC cardioversion!
52
Management of tachycardia w/ adverse features
Synchronised DC cardioversion (up to 3 times) 300mg amiodarone IV over 10-20min + repeat shock then 900mg amiodarone over 24h
53
Management of regular narrow-complex tachycardia
Valsalva manoeuvre Adenosine 6mg --\> if restores sinus rhythm probable SVT If fails --\> probable atrial flutter, consider beta blocker, seek expert help + similar management as acute AF Consider fleicanide or amiodarone for WPW AVRT
54
Management of regular broad-complex tachycardia
Amiodarone 300mg over 20-60min Then amiodarone 900mg over 24h Correct K+/Mg2+ (via central line) DC cardioversion **OR** adenosine if previously **confirmed** BBB (SVT +BBB --\> broad complex, but can cause haemodynamic instability in VT)
55
Management of irregular broad-complex tachycardia
Seek expert help **Differential:** pre-excited AF (amiodarone) AF + BBB (amiodarone) torsade de pointes (magnesium 2g) VF (non-synchronised DC shock)
56
Management of torsade de pointes
Stop predisposing drugs Correct K+/Mg Consider Mg sulfate High dose beta blockers if congenital long Q-T
57
Management of bradycardia
**Correct underlying disturbances!** Atropine 500 mcg IV if adverse features/recent asystole Isoprenaline 5mcg/min OR adrenaline 2-10 mcg/min for heart block Inform cardiology/ITU for transcutaneous pacing
58
Cardiac causes of bradycardia
**​Cardiac:** * Post-MI (esp inferior, RCA) * Degenerative --\> heart block * Aortic valve disease * Sick sinus syndrome * Myocarditis, cardiomyopathy, amyloid, sarcoid, SLE
59
Non-cardiac causes of bradycardia
Vasovagal Hypothyroidism, adrenal insufficiency Hyperkalaemia, hypoxia, hypothermia Raised ICP
60
Drugs causing bradycardia
Beta blockers Verapamil, diltiazem **Reverse above with glucagon** Digoxin Reverse with anti-dig antibody fragments
61
When to give non-synchronised DC shockes
Pulseless VF/VT
62
Leads V1-V2 view and blood vessel
Proximal LAD, septal
63
Leads V3-V4 view + blood vessel
Anterior, LAD
64
Inferior ECG leads
II, III, aVF RCA occlusion
65
Lateral MI
I + aVL Left Circumflex (also V5-V6)
66
Synchronised DC cardioversion energy
**Narrow-complex:** 70-120J **Broad complex:** 120-150J

Emergency medicine (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions