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Tachyarrhythmias Flashcards

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1
Q

What is an arrhythmia?

A

An abnormality of cardiac rhythm

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2
Q

What can arrhythmias cause?

A 
Sudden death
Syncope
Dizziness
Palpitations
Asymptomatic
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3
Q

What are the two broad categories of arrhythmias?

Describe them briefly!

A

Bradycardia: slow HR, less than 60 bpm

Tachycardia: fast HR, more than 100 bpm

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4
Q

What categories can tachycardias be subdivided into?

Describe them!

A 
Supraventricular tachycardias (SVT)
- arise from the atria or atrioventricular junction

Ventricular tachycardias
- arise from the ventricles

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5
Q

What is meant by sinus rhythm?

A

Rhythm controlled by the sinus node!

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6
Q

What is the normal cardiac pacemaker?

A

The sinus node

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7
Q

What is the sinus node?

What controls it?

A

A collection of cells found in the upper wall of the RA
It is the main pacemaker of the cell

It is controlled by the autonomic nervous system

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8
Q

What is sinus arrhythmia?

A

Arrhythmia caused by changes in the sinus rhythm, specifically the sinus discharge rate

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9
Q

What is sinus tachycardia?

Is it necessarily a bad thing?

A

Increase in sinus rhythm causing an increase in heart rate

No, it occurs naturally in response to exercise + excitement

It also occurs in response to fever, anaemia, heart failure, acute PE, and many more

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10
Q

What causes an arrhythmia? There are two mechanisms.

A

Cardiac rhythm not being generated correctly by SAN

Cardiac rhythm id generated correctly by SAN but is not conducted properly through the heart

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11
Q

What is re-entry?

Don’t describe

A

A process that occurs in the heart that is the cause of many types of arrhythmia

Involves the formation of abnormal electrical circuits in the heart

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12
Q

Describe what re-entry is, use the AV node as an example.

A

There are 2 pathways in the AVN, imagine a diamond shape, the pathways are on each side

  • slow, with short refractory time
  • fast, with long refractory time

In re-entry, the fast pathway gets transiently blocked, because a premature impulse from the SA node has meant the fast pathway is in its repolarisation phase so can’t be depolarised

No impulses can travel down the pathway but the tissue is still excitable

Impulses travel down the slow pathway as normal, but when they get to the apex (where fast and slow meet) the impulses start to travel back up the fast pathway in the wrong direction

You get retrograde conduction up the fast pathway, creating a re-entry circuit

This leads to arrhythmias

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13
Q

In which node do re-entry circuits form?

A

AV node

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14
Q

What are ectopic beats?

A

Electrical disturbances that arise from tissue that is not part of the usual heart conduction system

Can be ventricular or atrial

Cause benign, non-sustained arrythmias

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15
Q

A patient complains of feeling missed heart beats, that feel a bit like a heart hiccup. What does this sound like?

A

Ectopic beats

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16
Q

What is the difference between a narrow and broad complex tachycardia?

A

Narrow: ventricles are depolarised by the Purkinje fibres still (narrow QRS complex)

Broad: ventricles are not depolarised by the Purkinje fibres (broad QRS complex)

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17
Q

Describe the electrical conduction of the heart?

A

Impulse generated by SAN

Travel down internodal pathways causing atrial depolarisation

Impulse reaches AVN

Down AV bundle

Down either R or L bundle branch

Into Purkinje fibres causing ventricular depolarisation

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18
Q

Name 4 supraventricular tachyarrhythmias?

A

Atrial fibrillation

Atrial flutter

AVNRT: atrioventricular nodal re-entry tachycardia

AVRT: atrioventricular re-entry tachycardia

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19
Q

What is atrial fibrillation?

A

The SA node is conducting impulses irregularly

Causing the atria to not contract properly

And, some (not all) of the chaotic SA impulses are conducted to the ventricles, causing an irregular heartbeat

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20
Q

What does an ECG of atrial fibrillation look like?

A

Irregularly irregular chaotic heart rhythm

No P waves visible
QRS complexes appear normal but they occur irregularly

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21
Q

Name and describe 3 types of atrial fibrillation?

A

Paroxysmal: spontaneous termination within 7 days

Persistent: not self-resolving, needs treatment by cardioversion

Permanent: long standing, over 1 year, not treatable by cardioversion

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22
Q

List some causes of atrial fibrillation?

A 
Hypertension
CHD
Valve disease
Hyperthyroidism
Idiopathic
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23
Q

Clinical features of atrial fibrillation?

A 
Asymptomatic
Palpitations
Dyspnoea
Syncope
Stroke
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24
Q

Why does atrial fibrillation cause strokes?

A

The blood in the atria becomes stagnant in the atria because the fibrillation means it can’t be pumped out properly

Stagnant blood forms clots

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25
Complications of atrial fibrillation?
Stroke or other clotting problem Heart failure Cardiomyopathy
26
Investigations of arrhythmias in general?
ECG Bloods: including coagulation CXR ECHO
27
Management of atrial fibrillation?
HR control: beta blockers or sodium channel blocker (verapamil) Rhythm control: electrical or chemical cardioversion Thromboprophylaxis: warfarin, apixiban
28
What is atrial flutter?
Extremely fast atrial heart rate caused by re-entry circuits The AV node conducts some but not all of the impulses from SAN to the ventricles
29
What is meant by 2:1 atrial flutter
Atrial flutter Where the AV node is able to conduct every other impulse from the SAN to the ventricles
30
What is meant by 3:1 atrial flutter?
Atrial flutter Where the AV node is only able to conduct every 1 in 3 impulse from the SAN to the ventricles
31
What would the ECG of atrial flutter look like?
Extremely fast atrial heart rate of about 300 Saw tooth pattern Rapid, regular P waves
32
Causes of atrial flutter?
CHD Atrial dilatation Hypertension Obesity
33
Presentation of atrial flutter?
``` Palpitations Dyspnoea Syncope Heart failure Stroke ```
34
Management of atrial flutter?
Cardioversion Thromboprophylaxis Ablation of the part of the heart causing the arrhythmia, the re-entry circuit
35
What does AVNRT stand for?
Atrioventricular nodal re-entry tachycardia
36
What is AVNRT?
An accessory conduction pathway arises in the heart, between the atrium and the AVN Re-entry circuit is created causing arrhythmia
37
Causes of AVNRT?
Idiopathic, usually occurs in young adults, especially females
38
What would the ECG of AVNRT look like?
Rapid but normal QRS complexes Followed immediately by P waves, caused by the retrograde excitation of the atria from the re-entry circuit
39
Presentation of AVNRT?
``` Palpitations Chest pain Syncope Dyspnoea Neck pulsation ```
40
Management of AVNRT?
Adenosine: can block the AV node so blocking the abnormal impulses from getting to ventricles Ablation Medication: beta blockers, calcium channel blockers
41
What does AVRT stand for?
Atrioventricular re-entry tachycardia?
42
What is AVRT?
An accessory conduction pathway arises connecting the atria to the ventricles Re-entry circuit is formed causing arrhythmia
43
What complications can arise from AVRT? How does it occur?
Wolff-Parkinson White syndrome When the re-entry circuit begins to travel in both directions
44
What causes Wolff-Parkinson White syndrome?
A congenital abnormality
45
Presentation of AVRT?
Palpitations Syncope Dizziness
46
What are the usual causes of ventricular tachycardias?
Ischaemic heart disease Heart failure Congenital cardiomyopathies and structural heart defects
47
List some ventricular tachycardias?
Ventricular fibrillation Ventricular tachycardia Torsade de pointes Premature ventricular contractions
48
Is premature ventricular contraction a narrow or broad complex tachycardia?
Broad, because the contraction of the ventricles is not caused by the Purkinje fibres Caused by ectopic beats arising in the ventricles
49
What is premature ventricular contraction?
Ventricular ectopic beats cause abnormal ventricular contraction Contraction is slower than usual These ectopic beats can occur randomly or in patterns
50
What would an ECG of premature ventricular contraction look like?
Premature broad QRS complexes They can occur as a one off, or every other beat, or in patterns
51
Management of premature ventricular contraction?
None needed!
52
What is ventricular tachycardia (as a specific condition)?
A run of successive ventricular ectopic beats That take the heart rate above 100bpm Non-sustained = lasts less than 30 seconds Sustained = lasts more than 30 seconds
53
Non-sustained vs sustained ventricular tachycardia?
Non-sustained: the ectopic beats last less than 30 seconds Sustained: the ectopic beats last more than 30 seconds
54
What does the ECG of ventricular tachycardia (as a specific condition) look like?
Broad, odd looking QRS complexes that are all of the same shape Like this: /\/\/\/\/\/\ Occasional P waves are seen super-imposed onto the QRS complexes
55
Presentation of ventricular tachycardia (as a specific condition)?
``` Syncope Dyspnoea Angina Compromised CO V-fib Death ```
56
Management of Ventricular tachycardia?
Cardioversion
57
What is Torsades de Pointes?
Episodes of tachycardia interspersed with periods of bradycardia
58
Causes of Torsades de Pointes?
Long QT: congenital channelopathy Drugs
59
Torsades de Pointes involves periods of tachycardia interspersed with periods of bradycardia What are the risks that occur with each?
During the tachycardic sections there is a risk of going into V-fib and death During the bradycardic sections you develop long QT which carries a risk of death as well
60
What would an ECG of Torsade de Pointes look like?
Varying amplitude of QRS And varying width, indicating the tachy and bradycardic periods Waxing and waning of QRS amplitude and width
61
Management of Torsade de Pointes?
Correct the underlying cause If congenital, use beta blockers and implantable defibrillator
62
What is ventricular fibrillation?
Rapid, chaotic rhythm of ventricular contraction Resulting in no CO, and often death if not treated quick enough
63
What would an ECG of V-fib look like?
Chaotic ventricular rhythm characterised by irregular wavelets of electrical contraction No QRS complexes due to no ventricular contraction
64
Management of V-fib?
Urgent cardioversion Drugs, implantable pacemaker
65
What does a delta wave look like on an ECG? | What pathology does it indicate?
A convex shape to the QR line Indicates Wolff-Parkinson White syndrome
66
What is pulseless ventricular tachycardia?
1. HR greater than 180bpm 2. A very wide QRS complex. 3. Patient is pulseless 4. The rhythm originates in the ventricles
67
Treatment of pulseless ventricular tachycardia?
Cardioversion

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