Palpitations

Question 1

What is complete heart block?

Answer 1

Complete dissociation of the atria + ventricles, so no conduction through the AVN

Question 2

How may someone with complete heart block present?

Answer 2

Syncope
Hypotension
CV collapse
Sudden cardiac death

Others: fatigue, dizziness, reduced exercise tolerance, chest pain

Question 3

In complete heart block, where do ventricular escape mechanisms occur?

Answer 3

Anywhere from the AVN to bundle branches

Question 4

Which patients are less likely to be symptomatic?

Answer 4

Those with narrow complex escape rhythms (e.g. occurring above the bundle of His)

Question 5

Two most common causes of complete heart block

Answer 5

Ischaemia or infarct

Drugs

Pathology: infiltration/ fibrosis

Question 6

Metabolic causes of complete heart block

Answer 6

Hyperkalaemia

Hypothyroidism

Question 7

Drugs causing complete heart block

Answer 7

Excess digoxin

Combination of beta blockers + CCB

Question 8

ECG in complete heart block

Answer 8

Regular P-P

No relationship between P waves + QRS (more P waves than QRS)

Question 9

Mx of acute complete heart block

Answer 9

ABCDE!

Question 10

What drug is 1st line in acute complete heart block?

Dose/ Route/ Max dose

Answer 10

Atropine (500mcg IV)

Can repeat dose <3mg

Question 11

What drug can be used as a temporary measure in acute complete heart block?

Answer 11

Adrenaline

Question 12

Definitive Mx of complete heart block

Answer 12

Cardiac pacing

Question 13

Difference between ICD + pacemaker

Answer 13

Pacemaker: helps control abnormal rhythms. Uses electrical impulses to prompt heart beat. Can speed up slow HR or control a fast HR etc

ICD: monitors heart rhythm. If it senses a dangerous rhythm a shock is delivered. ICD = PACEMAKER + DEFIBRILATOR

Question 14

What is first degree heart block?

Answer 14

Prolonged PR

Question 15

Second degree heart block:
Mobitz I
Mobitz II

Answer 15

Mobitz I: PR becomes longer + longer until a QRS is dropped (Wenckebach phenomenon)

Mobitz II: QRS is regularly missed (e.g 2:1 block)

Question 16

What is SVT?

Answer 16

Supraventricular tachycardia
Originates above the ventricles - in atria or AVN

Abnormal electrical activity triggers abnormal rhythm (hear accelerates too quickly + doesn’t allow time for it to fill before contraction0

Question 17

RFs of SVT

Answer 17

Age, heart disease, thyroid problems, drugs, anxiety, obstructive sleep apnoea

Question 18

What is the most common SVT?

Who does it affect?

Answer 18

AVNRT (atrioventricular nodal re-entrant tachycardia)

YOUNG WOMEN

Question 19

Mx of SVT

Answer 19

Vagal manouvre (1st line)

If ineffective, given ADENOSINE

Question 20

Does adenosine have a long or short duration of action?

Answer 20

VERY SHORT!

Question 21

Symptoms of SVT

Answer 21

Palpitations, dizziness + light-headedness

Question 22

What is VT?

Answer 22

Abnormal electrical signals in the ventricles = heart beats fast + out of sync with atria

Question 23

When is VT usually symptomatic?

Answer 23

When it lasts >30 seconds

Question 24

Symptoms of VT

Answer 24

Dizziness, light-headedness, palpitations, chest pain, LOC

Question 25

Sustained episodes of VT may lead to...

Answer 25

LOC + cardiac arrest

Question 26

Biggest RF for VT

Answer 26

Pre-existing heart problem (e.g. post-MI)

Question 27

What factors make VT a more likely diagnosis than SVT

Answer 27

Patient is >60 History of IHD QRS >0.13 Capture/ fusion beats

Question 28

ECG criteria for VT

Answer 28

Brugada criteria

Question 29

What is toursades de pointes?

Answer 29

Rare polymorphic VT with QRS of increasing + decreasing magnitude

Question 30

Causes of toursades de pointes?

Answer 30

Hypomagnesia, hypokalaemia, prolonget QT (e.g. in tricyclics OD)

Question 31

Mx of VT: If unstable If stable

Answer 31

Unstable: DC x 3, followed by IV amiodarone Stable: IV amiodarone

Question 32

What else can be used to treat VT in haemodynamically stable

Answer 32

IV lidocaine

Question 33

Pathophysiology of VF

Answer 33

Rapid, erratic heartbeats = hear abruptly stops beating

Question 34

Cause of VF

Answer 34

Problem with the heart's electrical impulses after a previous MI or something else causing scarring of the myocardium

Question 35

Is there a pulse in VF?

Answer 35

NO!!

Question 36

Management of VF

Answer 36

CPR + immediate defibrilation

Question 37

What is the most common cause of sudden cardiac death?

Answer 37

VF