Arrythmias: Pathophysiology, Presentation + Investigation

Question 1

How can an arrhythmia present?

Answer 1

• Asymptomatic
• Palpitations
• Dyspnoea
• Chest pain
• Fatigue
• Embolism

Question 2

How are arrhythmias investigated?

Answer 2

• Document arrhythmia on 12 lead ECG, 24 hr recording/ event recorder
• Blood tests including thyroid function
• ECHO

Question 3

What are the therapeutic approaches?

Answer 3

• Rate control vs rhythm control

- Consider anticoagulation

Question 4

How is supraventricular tachycardia described?

Answer 4

AV node re-entrant tachycardia

Question 5

How does SVT present?

Answer 5

• Palpitations
• Dyspnoea
• Dizziness

Question 6

What is the prognosis for SVT?

Answer 6

-Good

Question 7

What is the treatment for SVT?

Answer 7

• Drugs

- RFA

Question 8

What can SVT be due to?

Answer 8

Accessory pathway- WPW if overt

Question 9

What is the treatment for atrial flutter?

Answer 9

• Control ventricular rate and thromboembolic risk
• Usually cardiovert
• Prevent with AA drugs or RFA of cavotricuspid isthmus

Question 10

What protocol should be followed for ventricular fibrillation?

Answer 10

Cardiac arrest protocol

Question 11

What does ventricular tachycardia present with?

Answer 11

• Palpitations
• Chest pain
• Dyspnoea
• Dizziness
• Syncope

Question 12

What is VT usually due to?

Answer 12

Structural heart disease

Question 13

What investigations should be carried out for VT?

Answer 13

• Bloods
• ECHO
• Angio
• etc

Question 14

How is VT treated?

Answer 14

• Cardiac arrest protocol
• DC cardioversion
• Drugs

Question 15

How is VT prevented?

Answer 15

• Treatment of underlying cause

- AA drugs and/or ICD

Question 16

What causes long QT syndrome?

Answer 16

Congenital or acquired

Question 17

What can LQT syndrome cause?

Answer 17

TdP

Question 18

What is the treatment for LQT syndrome?

Answer 18

• Drugs
• Pacing
• ICD

Question 19

What are the indications for ICD therapy as secondary prevention?

Answer 19

• Cardiac arrest due to VF/VT not due to transient or reversible cause (early phase of acute MI)
• Sustained VT causing syncope or significant compromise
• Sustained VT with poor LV function

Question 20

What are the indications for temporary pacing?

Answer 20

• Intermittent or sustained symptomatic bradycardia particularly syncope
• Prophylactic when patient at high risk for development of severe bradycardia

Question 21

What are the indications for permanent pacing?

Answer 21

• Symptomatic or profound 2nd/3rd degree AV block particularly when cause is unlikely to disappear
• Probably Mobitz type II 2nd/3rd degree AV block even if asymptomatic
• AV block associated with neuromuscular diseases
• After AV node ablation
• Alternating RBBB/LBBB
• Syncope when bifascicular/trifascicular and no other explanation
• Sinus node disease associated with symptoms
• Carotid sinus hypersensitivity/malignant vasovagal syncope