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Phase 4 - Cardiology > Tachyarrhythmias > Flashcards

Tachyarrhythmias Flashcards

1
Q

What is the definition of a narrow complex tachycardia?

A

Heart rate > 100bpm and a QRS less than 120ms

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2
Q

What are some examples of REGULAR narrow complex tachycardia?

A
  • Sinus tachycardia
  • focal atrial tachycardia
  • Atrial flutter,
  • Atrioventricular re-entry tachycardia (occurs when there is an accessory pathway - WPW)
  • Atrioventricular nodal re-entry tachycardia - SVT
  • Junctional tachycardia
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3
Q

What are some causes of IRREGULAR narrow complex tachycardia?

A
  • Atrial fibrillation - irregularly irregular rhythm with no P waves.
  • Atrial flutter with variable block
  • Multifocal atrial tachycardia (COPD)
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4
Q

What are the symptoms and signs of narrow complex tachycardia?

A

Symptoms: Palpitations, lightheadedness, dyspnoea, chest pain, syncope
Signs - tachycardia. Hemodynamic instability (shock, chest pain, heart failure or syncope)

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5
Q

What are the investigations for a narrow complex tachycardia?

A
  • ECG,
  • 24 hour tape is rhythm is paroxysmal
  • Bloods (electrolytes)
  • Imaging (ECHO)
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6
Q

What is the management of a regular narrow complex tachycardia?

A
  • A-E exam. If signs of hemodynamic instability then synchronized DC cardioversion +/- amiodarone
  • 1st line = Vagal maneuvers (valsalva or carotid sinus massage)
  • 2nd line = Rapid bolus of adenosine (verapamil is asthmatic). Start with 6mg, if unsuccessful then 12mg, if unsuccessful then 18mg.
  • 3rd line is electrical cardioversion
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7
Q

How can you prevent episodes of SVT?

A

Beta blockers or radiofrequency ablation

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8
Q

What is the management of acute irregular narrow complex tachycardia?

A
  • If probable AF then beta blockers (not in the context of sepsis)
  • If signs of heart failure then digoxin
  • If onset was >48 hours then anticoagulation
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9
Q

What are the types of atrial fibrillation?

A
  • Paroxysmal AF (episodes usually last less than 24 hours but must last than 7 days)
  • Persistent AF (Lasts more than 7 days and doesn’t terminate)
  • Permanent AF (cannot be cardioverted)
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10
Q

What is the principles of managing AF?

A
  • Rate control (most common) of rhythm control
  • Stroke prevention
  • Catheter ablation in area between pulmonary veins and left atrium. (in those whose AF has not responded to antiarrhythmic meds
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11
Q

What are the causes of AF?

A
  • Ischaemic heart disease,
    Hypertension,
    Symptomatic heart failure,
    Valvular heart disease,
    Cardiomyopathies,
    ASD/other congenital heart disease,
    Coronary artery disease,
    Thyroid dysfunction,
    Obesity,
    Diabetes mellitus,
    COPD and sleep apnoea,
    Chronic renal disease
  • Non cardiac causes: dehydration, hyperthyroidism, sepsis, pneumonia/PE, alcohol abuse, hypokalaemia or hypomagnesaemia
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12
Q

When should rhythm control be offered for AF?

A
  • AF secondary to a reversible cause,
  • Heart failure thought to be caused by AF,
  • New onset AF
  • Younger patients
  • Symptomatic patients despite good rate control
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13
Q

Describe features of rate control for AF

A
  • First line - Beta blocker (bisoprolol) or rate limiting calcium channel blocker (contra-indicated in heart failure).
  • If hypotension or heart failure then use Digoxin as first line
  • Second line = Combination of 2 of following: beta-blocker, diltiazem or digoxin
  • Aim for HR <110 but if still symptomatic then aim <80bpm
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14
Q

Describe features of rhythm control

A
  • Can only be done if onset is less than 48h or they have been anti-coagulated for >3 weeks. Can be done via meds or DC cardioversion.
    Meds: Flecanide (pill in pocket or given regularly. Fatal in those with structural heart disease). Amiodarone (for older, sedentary patients). Sotalol (for those who dont meet demographics for flecanide or amiodarone)
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15
Q

Explain the CHA2DS2VASc score

A

C - congestive HF,
H - Hypertension
A2 - Age > 75
D - diabetes,
S2 - Prior stroke, TIA or thromboembolism
V - vascular disease
A - Age 65-74
S - Female sex
Offer anticoagulation if men score 1+ and women score 2+

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16
Q

What is the anticoagulation for AF?

A
  • DOAC (first line)
  • Warfarin: requires cover with LMWH for 5 days when initiating as warfarin is initially prothrombotic. Used for valvular AH
17
Q

What scoring system is used to assess risk of bleeding?

A

ORBIT score: Sex, Hb, Age >74, bleeding history, renal function and use of antiplatelets

18
Q

When should you start anticoagulation in AF patients post stroke?

A
  • If they had a TIA then start anticoagulation as soon as haemorrhage is excluded.
  • In stroke patients anticoagulation should start 2 weeks after stroke. Antiplatelet should be given during this time period.
19
Q

What are the complications of atrial fibrillation?

A
  • Heart failure
  • Systemic emboli
  • Bleeding
20
Q

What are the causes of atrial flutter?

A

Similar to AF but more likely to occur with pulmonary disease such as COPD, obstructive sleep apnoea, pulmonary emboli or pulmonary hypertension

21
Q

What is the treatment for atrial flutter

A

If haemodynamically unstable - Cardioversion
If haemodynamically stable then treat reversible cause and rate control using BB or CCB

22
Q

Name examples of broad complex tachycardia

A
  • Monomorphic ventricular tachycardia: Most commonly caused by MI.
  • Polyphorphic VT, eg, torsades de pointes which is caused by prolongation of the QT interval.
23
Q

what are some causes of QT prolongation?

A

Congenital: Jervell-Lange-Nielsen syndrome, Romano-Ward syndrome
Drugs: Amiodarone, Tricyclic antidepressants, fluoxitine, cloroquine, erythromycin, quinolones.
Other: Hypokalaemia, hypocalaemia, hypomagnesaemia, acute MI, myocarditis, hypothermia, SAH

24
Q

What are the ECG findings of VT?

A
  • Tachycardia
  • Abscent P waves,
  • broad QRS >120ms
25
Q

What is the management of VT?

A

Pulseless - 200J unsynchronised shock, IC adrenaline and IV amiodarone administered after 3rd shock. Then Adrenaline every 3-5mins.
Pulsed VT with haemodynamic instability - Synchronised DC shocks and senior guided amiodarone
Pulsed VT with haemodynamic stability - Amiodarone 300mg over 10-60mins, if ineffective then DC shocks
Never use verapamil!!

26
Q

What are features of ventricular fibrillation and ECG findings

A
  • VF is an irregular broad complex tachy. It is ALWAYS pulseless.
  • ECG: Tachycardia, QRS complexes which are polymorphic and irregular
27
Q

What is the management of VF?

A
  • 200J biphasic unsynchronised shock
  • IV adrenaline (1mg of 10ml 1:10,000) and IV amiodarone (300mg) after 3rd shock.
  • Adrenaline every 3-5mins thereafter
28
Q

What is the management of torsades de pointes

A

IV magnesium sulphate

Phase 4 - Cardiology (15 decks)

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