arrhythmia

Question 1

what can arrhythmias cause

Answer 1

• sudden death
• syncope
• heart failure
• chest pain
• dizziness
• palpitations

Question 2

what are 2 main types of arrhythmias

Answer 2

• bradycardia. (<60bpm)

- tachycardia(>100 bpm)

Question 3

what are tachycardia subdivided into

Answer 3

• SVT

- ventricular

Question 4

what leads to tachycardia

Answer 4

• reduction of parasympathetic tone

or

• increase in sympathetic tone

Question 5

what produces bradycardia

Answer 5

• increased parasympathetic

or

• decreased sympathetic

Question 6

who has faster sinus rate men or women

Answer 6

women

Question 7

what is normal sinus rhythm characterised by on ECG

Answer 7

p waves upright in leads I and II

Question 8

why is sinus bradycardia in athletes

Answer 8

due to their increased vagal tone

Question 9

extrinsic causes of bradycardia

Answer 9

• hypothermia
• drug therapy e.g. beta blocker
• raised intracranial pressure

Question 10

intrinsic causes of bradycardia

Answer 10

• infarction of sinus node

- fibrosis

Question 11

what. does chronic symptomatic sick sinus require

Answer 11

permanent pacing

Question 12

how many forms of atrioventricular block is there

Answer 12

3

Question 13

what is first degree AV block

Answer 13

prolongation of PR interval

Question 14

what are 2 forms of second degree AV block

Answer 14

Mobitz I

Mobitz II

Question 15

what is Mobitz I

Answer 15

progressive PR interval prolongation until p wave fails

Question 16

what is Mobitz II

Answer 16

every nth p wave is dropped

Question 17

when is pacing indicated

Answer 17

in Mobitz II

Question 18

what may an acute MI produce

Answer 18

second degree heart block

Question 19

what is third degree AV block

Answer 19

complete heart block

Question 20

what infection can cause AV block

Answer 20

• endocarditis
• lyme disease
• chagas disease

Question 21

what does narrow complex escape rhythm imply

Answer 21

that it originates in the His Bundle

Question 22

what does the left bundle subdivide into

Answer 22

anterior and posterior divisions of left bundle

Question 23

what is complete bundle branch block do to QRS

Answer 23

widen it up to >0.12 secs

Question 24

right bundle branch block produces

Answer 24

late activation of the right ventricle

Question 25

what is seen in ECG of right bundle branch block

Answer 25

deep S wave in leadsI and V6 tall late R wave in V1 looks like an M (MaRRoW)

Question 26

what does left bundle branch block look like on ECG

Answer 26

deep S wave in lead V1 tall R wave in leads I and V6 W shape (MaRRoW)

Question 27

what is bifsacicular block

Answer 27

is a combination of a block of any two of the following: right bundle branch left antero-superior division left posterior-inferior division

Question 28

symptoms of right bundle branch block

Answer 28

splitting of second heart sound

Question 29

what does right branch block occur

Answer 29

- isolated congenital anomaly - atrial or ventricular septal defect - pulmonary stenosis - Fallots tetraology - pulmonary embolism - pulmonary hypertension - MI - fibrosis

Question 30

causes of left bundle branch block

Answer 30

- aortic stenosis - hypertension - MI - coronary disease

Question 31

where do SVT arise from

Answer 31

the atrium or atrioventricular junction

Question 32

what is conduction via in SVT

Answer 32

His-Purkinje system

Question 33

sinus tachycardia ECG

Answer 33

similar to sinus rhythm

Question 34

atrioventricular nodal re-entrant tachycardia ECG

Answer 34

no visible p wave

Question 35

atrioventricular re-entrant tachycardia ECG

Answer 35

p wave visible between QRS and T

Question 36

atrial fibrillation ECG

Answer 36

irregularly irregular RR

Question 37

atrial flutter ECG

Answer 37

waves at 300. bpm sawtooth appearance 2:1 AV conduction

Question 38

multifocal atrial tachycardia ECG.

Answer 38

multiple p wave morphologies irregular RR intervals

Question 39

what is sinus tachycardia a sign of

Answer 39

cardiac stress - physiological or pathological

Question 40

acute causes of sinus tachycardia

Answer 40

- exercise - emotion - pain - fever - infection - acute heart failure - acute pulmonary embolism - hypokalaemia

Question 41

chronic causes of sinus tachycardia

Answer 41

- pregnancy - anaemia - hyperthyroidism - catecholamine excess

Question 42

what should be used to slow the sinus rate in hyperthyroidism

Answer 42

beta blockers

Question 43

who is atrioventricular nodal re-entrant tachycardia more common in n

Answer 43

women

Question 44

where are accessory pathways most commonly situated

Answer 44

on the left

Question 45

what is most common accessory pathway known as

Answer 45

Kent bundles

Question 46

are accessory pathways that conduct form the ventricles to the atria visible on ECG

Answer 46

no they are concealed

Question 47

what is a pre excited ECG characterised by

Answer 47

short PR interval | wide QRS

Question 48

what have patients with a history of palpitation and pre-excited ECG have

Answer 48

Wolff-Parkinson-White syndrome

Question 49

during atrial fibrillation what can the ventricles be depolarised by

Answer 49

impulses travelling over both abnormal and normal pathways

Question 50

what drugs can precipitate ventricular fibrillation

Answer 50

verapamil | digoxin

Question 51

what drugs should not be used to treat WPW syndrome

Answer 51

verapamil | digoxin

Question 52

symptoms of SVT

Answer 52

- palpitations (abrupt onset and sudden termination) - anxiety - dizziness - dyspnoea - neck pulsation - central chest pain - weakness - polyuria

Question 53

how can SVT palpitations be terminated

Answer 53

valsalva manouevres

Question 54

what can irregular palpitations be due to

Answer 54

atrial premature beat atrial flutter atrial fibrillation multi-focal atrial tachycardia

Question 55

what can happen in patients with uncontrolled atrial fibrillation

Answer 55

cardiac output can reduce and cause hypotension and congestion heart failure

Question 56

why may polyuria occur in SVT

Answer 56

because of release of atrial natriuretic peptide in response to increased atrial pressure

Question 57

why does prominent jugular venous pulsation occur during SVT

Answer 57

due to atrial contracts against closed AV valves

Question 58

treatment of SVT in patient who is haemodynamcially unstable

Answer 58

emergency cardioversion

Question 59

treatment of SVT in stable patient

Answer 59

vagal manoeuvres | e.g. right carotid massage, face in cold water

Question 60

how should valsalva manoeuvre be done

Answer 60

patient is resting in supine position

Question 61

what is does next if physical manoeuvres are not successful in SVT

Answer 61

intravenous adenosine

Question 62

what is adenosine

Answer 62

naturally occurring purine nucleoside it causes complete heart block for a fraction of a second

Question 63

what is half life like in adenosine

Answer 63

very short

Question 64

what are side effects of adenosine

Answer 64

- bronchospasm - flushing - chest pain - heaviness in limb - sense of impending doom

Question 65

when is adenosine contraindicated

Answer 65

people with asthma as it can induce atrial fibrillation

Question 66

what is alternative treatment for adenosine

Answer 66

verapamil or beta blockers

Question 67

what is long term management of. SVT

Answer 67

referred to cardiologist ablation of an accessory pathway

Question 68

examples of sodium channel blockers

Answer 68

flecainide

Question 69

where do atrial tachyarrhythmias arise

Answer 69

atrial myocardium

Question 70

what are atrial tachyarrhythmias caused by

Answer 70

- increasing age - MI - hypertension - obesity - diabetes mellitus - myocarditis - pericarditis - surgery - electrolyte imbalance - alcohol - chest infection - hyperthyroidism