Flashcards in Arrhythmias Deck (6):
What are the causes of arythmmia?
VT – Electrolyte abnormalities, Ischaemic heart disease, cocaine, cardiomyopathy, MI, Heart failure
SVT – Ischaemic heart disease, thyrotoxicosis, caffeine, alcohol, smoking
AF - Ischaemic heart disease, thyrotoxicosis, caffeine, alcohol, smoking, mitral valve disease, hypertension, lung disease, post op, pericardial disease, cardiomyopathy, infection
What are the main types of Arrhythmia?
Bradycardia - Heart block is caused by AVN problems whereas sinus bradycardia or sick sinus syndrome are caused by the atrial problems
Sinus Bradycardia - Normal Sinus Rhythm but heart rate <100bpm.
1st degree Heart Block - prolonged PR interval, no treatment needed
2nd degree Heart Block type 1 - Prolonged PR until QRS - No treatment
2nd degree Heart Block type 2 - Different pattern to P and R waves, e.g. 2 P waves to each QRS
3rd Degree pacemaker - Random P an QRS rates. Each have their own rate. - Required pacemaker
Narrow Complex Tachycardia: QRS<3ss and >100bpm. These are caused by Supraventricular Problems
AVRT (Circuit loops within accessory pathways during conduction)
AVNRT (Circuit loops within the AV node causing rapid pulsation)
Wolfe Parkinson White
Broad Complex Tachycardia: Q>3ss and >100bpm. These are caused by Ventricular Problems
Torsade’s De Pointes
Any narrow complex tachycardia + bundle branch block
What will you find/ask about in a history of Arrhythmia?
Heart Failure - Pulmonary Oedema
Sudden Cardiac Death
Can be Asymptomatic
Family history of early cardiac death
Any underlying hyperthyroidism, ask about symptoms
Specific questions to ask in a history taking:
Frequency of symptoms
Are they constant or paroxysmal?
Aggravating factors - Anything that brings them on (specifically caffeine and stimulants)
Are they regular or irregular (get them to tap it out)?
Are the symptoms present now?
Onset of symptoms with exercise is a red flag
Ask about stress/anxiety as this can be a cause
Do they have a specific start/end - Cardiac palpitations have set time they start and stop, but others e.g. anxiety do not have a set time they start/stop and come on gradually?
Panic Attacks - Palpitations follow feelings of panic, can be hard to differentiate. May feel numbness tingling in the mouth and fingers
What will you look for/find in an examination of a patient with a suspected Arrhythmia?
End of the bed:
Look for any oedema indicating heart failure
Feel pulse – To assess rate, rhythm, character. Irregularly irregular think AF, regularly irregular think ventricular ectopic
Pale palmar creases may indicate precipitating anaemia
Fine tremor – Indicates thyrotoxicosis or anxiety
Raised JVP in underlying RHF
Pale conjunctiva may indicate precipitating anaemia
Listen for any murmurs or signs of valve disease/IHD
Pulmonary crackles in underlying LHF
What are the investigations you will order in suspected arrhythmia?
ECG - Looking for an arrhythmia or underlying heart condition e.g. Previous MI, Heart Failure
Glucose - Rule out Hypoglycaemia and assess cardiovascular risk
FBC – Looking for Anaemia or infection (can precipitate AF)
U&E - Electrolyte disturbances cause arrhythmias
Ca2+ and Mg2+ - Electrolyte disturbances cause arrhythmias
TFT’s - Thyrotoxicosis can cause arrhythmias
LFT’s – Find out why
CXR - Looking for Heart Failure
Echo - Look at structural changes e.g. mitral stenosis or cardiomyopathy
24-hour ECG monitoring - to look for paroxysmal AF and other intermittent arrhythmias
Exercise stress ECG - To look for any coronary artery disease
Cardiac catheter - To look for any coronary artery disease