Arrhythmia

Question 1

What is an arrhythmia?

Answer 1

An abnormal heart rate or rhythm.

Question 2

Common symptoms of arrhythmia?

Answer 2

• Asymptomatic
• palpitations
• decompensated heart failure/cardiac disease
• syncope
• sudden death.

Question 3

What ECG feature defines 1st degree AV block?

Answer 3

Prolonged PR interval.

Question 4

What does the PR interval represent?

Answer 4

Conduction time from onset of P wave to start of QRS (through the AV node).

Question 5

Normal PR interval?

Answer 5

120–200 ms (3–5 small squares).

Question 7

Example PR interval given for 1st degree AV block?

Answer 7

320 ms (8 small squares).

Question 8

What is Mobitz type I also called?

Answer 8

Wenckebach.

Question 9

What is a 2:1 AV block?

Answer 9

Only every second atrial impulse conducts to the ventricles (so fewer QRS complexes than P waves).

Question 10

What is a 3:1 AV block?

Answer 10

Only every third atrial impulse conducts to the ventricles.

Question 11

What is 3rd degree AV block?

Answer 11

Complete AV block (no conduction from atria to ventricles; atria and ventricles beat independently).

Question 12

Complete AV block (no conduction from atria to ventricles; atria and ventricles beat independently).

Answer 12

• QRS >120 ms
• dominant S wave in V1
• broad dominant R wave in lateral leads without Q wave.

Question 13

ECG criteria for RBBB?

Answer 13

• QRS >120 ms
• RSR’ (“M-shaped”) in V1–V3
• wide slurred S wave in lateral leads (I, aVL, V5–V6)
• ST depression and T inversion in V1–V3.

Question 14

Name common narrow-complex regular tachyarrhythmias.

Answer 14

Sinus tachycardia, atrial flutter, AVNRT.

Question 15

In atrial flutter with 2:1 block, what is the ventricular rate?

Answer 15

~150 bpm and regular.

Question 15

What is the typical atrial rate in atrial flutter?

Answer 15

~300 bpm.

Question 16

What do flutter waves look like (key idea)?

Answer 16

• Regular flutter waves (often described as saw-tooth)
• ~1 flutter wave per big box.

Question 17

Key ECG features of AVNRT?

Answer 17

• No visible P waves
• narrow complex (unless additional block)
• regular rhythm.

Question 18

Key ECG features of atrial fibrillation (AF)?

Answer 18

• No P waves
• narrow complex (unless additional block)
• irregularly irregular rhythm.

Question 19

Key ECG features of monomorphic VT?

Answer 19

• No P waves
• broad complex
• regular rhythm with one consistent morphology.

Question 20

What does VF look like on ECG?

Answer 20

• No P waves
• chaotic irregular waveform (“scribble”)
• no organised QRS.

Question 21

How common is AF?

Answer 21

• ~0.5–1% of the general population
• ~10% of people over 65.

Question 22

Why are there no distinct P waves in AF?

Answer 22

No organised atrial activity.

Question 23

What is the atrial rate in AF (conceptually)?

Answer 23

> 300 bpm with chaotic multiple foci.

Question 24

Why is the ventricular rhythm irregular in AF?

Answer 24

Conduction through the AV node is variable/random.

Question 25

How can AF affect quality of life?

Answer 25

Symptomatic AF (especially fast AF) can cause patients to feel very unwell.

Question 26

What is tachy-induced cardiomyopathy?

Answer 26

Persistent fast AF leading to reduced cardiac function and heart failure.

Question 27

What is “loss of atrial kick” and why does it matter?

Answer 27

Loss of atrial contraction reduces LV filling (~30% contribution), especially important in diastolic dysfunction or impaired ventricular function.

Question 28

Why does AF increase stroke risk?

Answer 28

Blood becomes relatively static in atria (esp. left atrial appendage) → clot formation → embolisation to brain → ischaemic stroke.

Question 29

Define paroxysmal AF.

Answer 29

Intermittent episodes that terminate spontaneously.

Question 30

Define persistent AF.

Answer 30

Requires medical intervention to terminate.

Question 31

Define permanent AF.

Answer 31

Rhythm control doesn’t restore or maintain sinus rhythm (or not attempted).

Question 32

What is CHA₂DS₂-VASc used for?

Answer 32

Estimating stroke risk in AF to guide anticoagulation.

Question 33

Components of CHA₂DS₂-VASc?

Answer 33

- CCF - Hypertension - Age (65–74 =1; ≥75 =2) - Diabetes - Stroke/TIA/TE (=2) - Vascular disease, Sex.

Question 34

What is HAS-BLED used for?

Answer 34

Estimating bleeding risk when considering anticoagulation.

Question 35

Components of HAS-BLED?

Answer 35

- Hypertension - Abnormal renal/liver function (and age in your notes) - Stroke -Bleeding history/predisposition - Labile INR - Elderly - Drugs/alcohol.

Question 36

First-line anticoagulation for stroke prevention in AF?

Answer 36

DOACs.

Question 37

DOAC guidance by CHA₂DS₂-VASc?

Answer 37

- Score = 1: “consider” - score ≥2: “offer”.

Question 38

When is warfarin still first line?

Answer 38

Mechanical (metal) heart valve replacement.

Question 39

When is LMWH used in AF?

Answer 39

- Bridging therapy - also in severe renal failure when DOAC/warfarin not suitable.

Question 40

First-line rate control options in AF?

Answer 40

- Beta blocker (bisoprolol/metoprolol) - rate-limiting CCB (diltiazem) - digoxin.

Question 41

When consider rhythm control?

Answer 41

If symptoms persist despite rate control.

Question 42

Drugs used for pharmacological cardioversion/maintenance (as per notes)?

Answer 42

Amiodarone, flecainide.

Question 43

When is electrical cardioversion used?

Answer 43

Life-threatening haemodynamic instability acutely or planned outpatient cardioversion.

Question 44

What is left atrial ablation and why is it done?

Answer 44

- Used when drugs fail/unsuitable - pulmonary veins can trigger AF - so ablation creates scar to isolate abnormal impulses.

Question 45

What does LAAO stand for?

Answer 45

What does LAAO stand for?

Question 46

How common is atrial flutter compared with AF?

Answer 46

The most common arrhythmia after AF.

Question 47

How should atrial flutter be treated regarding stroke risk?

Answer 47

Treat similarly to AF (especially anticoagulation decisions).

Question 48

What is atrial flutter with variable block?

Answer 48

Changing conduction ratio causing changing ventricular rate/irregularity.

Question 48

What is atrial flutter with 4:1 block?

Answer 48

Only every 4th flutter wave conducts to the ventricles (slower ventricular rate).