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Flashcards in ventricular arrhythmias Deck (35)
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1

what are the main VAs? 5

ventricular tachyarrhythmias
- torsades des pointes
- ventricular fibrillation
- premature ventricular complex
- asystole

2

what does TdP look like on an ECG?

like VF but it is actually VT with varying axis

- there is a broad QRS complex and continuously changing QRS morphology

3

is the rhythm regular or irregulaar in TdP?

irregular

4

what may be the events leading to TdP?

- hypokalaemia
- prolongation of the action potential (drug induced)
- renal impairment (increased drug levels)

5

what does PVC look like on ecg?

very borad QRS

6

There is a fall in ___ following the ectopic beat - the patient might feel light headed

There is a fall in BP following the ectopic beat - the patient might feel light headed

7

what are some of the causes of PVC?

- Ischaemic heart disease,
- hypertension with left ventricular hypertrophy
- heart failure
- May be marker for inherited arrhythmia syndromes e.g. cardiomyopathy

8

if PVC worse on ______, need to investigate further

If worse on exercise, need to investigate further

9

what drugs are used in the treatment of PVC?

b blockers

10

most patients who get VT have significant heart disease , such as....

- coronary artery disease
- previous MI

11

what are the rare causes of VT?

- cardiomyopathy
- inherited/ familial syndromes

12

give some examples of inherited/familial arrhythmia syndrome that can cause VT?

long QT

brugada syndrome

13

what is the difference between monomorphic and polymorphic VT?

monomorphic - the qrs stay relatively stable

14

why do the QRS stay relatively stable in monomorphic VT?

each ventricular impulse is being generated from the same place in the ventricles

15

monomorphic VT is usually due to ______

scarring

16

polymorphic VT is usually due to ______ _ _______

TdP

17

what is VF?

a chaotic ventricular electrical activity which causes the heart to lose the ability to function as a pump

18

what is the treatment for VF?

- DC cardioversion
- cardiopulmonary resuscitation

19

what is the abnormilty in conduction in brugada syndrome?

there are faulty sodium channels which predispose to fatal arrhythmias

20

which group of people typically get brugada?

young males

21

what can trigger brugada?

fever

22

how do you prevent the arrhythmias caused by brugada if you know someone has it?

ICD

23

how do you manage acute long QT syndrome?

- correct any electrolyte disturbance
- stop causative drugs
- heart rate maintaed with atrial or ventricular pacing
- IV isoprenaline when QT prolongation is acquired

24

when do you not use isoprenaline in treatment of long QT?

when QT prolongation is congenital

25

what is the long term management of long QT?

- beta blockers
- left cardiac sympathetic denervation
- pacemaker therapy

26

what are the causes of VT and VF?

- mainly due to structural heart disease
- can be primary electrical disease though

27

what is the treatment for acute VT?

- dc cardioversion if unstable
acute CV only if it is an emergency

- if stable consider pharmcologic cardioversion with AAD

- consider adenosine to make a diagnosis

28

what may be the causes of VT?

- electrolyte- hypokalaemia hypomagnesaemia
- ischaemia
- hypoxia
- medications that prolong the QT interval

29

which medications may prolong the QT interval?

sotalol. quinidine, terfenadine, erythromycin, digoxin

30

what are the treatment steps according to cheese and onion? part 1

- Give high-flow oxygen by face mask.
- Obtain IV access. Send U&E, cardiac enzymes, Ca2+, Mg2+. Correct low K+or Mg2+.
- Obtain 12-lead ECG.
- ABG (if evidence of pulmonary oedema, reduced conscious level, sepsis).
- Amiodarone IVI. Phlebitis may result if peripheral line used, especially if concentration >2mg/mL. Rarely, lidocaine 50mg over 2min instead, followed by infusion; see BNF.