phase 2 michelle mair the peer teaching society is not liable for false or misleading information…
TRANSCRIPT
Phase 2
Michelle Mair
Cardiovascular 2
The Peer Teaching Society is not liable for false or misleading information…
Arrhythmias:- Atrial fibrillation- Atrial flutter- Heart block- Sinus tachycardia- SVTs- Ventricular ectopics- Prolonged QT syndrome- Aberrant pathways
The Peer Teaching Society is not liable for false or misleading information…
Aims
The Peer Teaching Society is not liable for false or misleading information…
ECGs
1) Heart Rate 2) Heart Rhythm
3) Cardiac axis4) P waves
5)P-R interval6) QRS complex7) ST segment
8) T waves
The Peer Teaching Society is not liable for false or misleading information…
Cardiac axis
The Peer Teaching Society is not liable for false or misleading information…
I
IIIII
AVLAVR
AVF
Normal Axis
Positive
Positive
Positive
Cardiac axis
The Peer Teaching Society is not liable for false or misleading information…
I
IIIII
AVLAVR
AVF
Right Axis Deviation
Negative
Positive
Positive
Cardiac axis
The Peer Teaching Society is not liable for false or misleading information…
I
IIIII
AVLAVR
AVF
Left Axis Deviation
Positive
Negative
Negative
The Peer Teaching Society is not liable for false or misleading information…
Atrial Fibrillation• Irregularly irregular rhythm • Varying rate• Absent p waves
The Peer Teaching Society is not liable for false or misleading information…
Atrial Fibrillation
Types:
1. Paroxysmal= spontaneous termination within 7 days, most commonly
in 48 hours
2. Persistent= not self-limiting, lasting longer than 7 days or prior to
cardioversion
3. Permanent= long standing (over 1 year) not terminated by
cardioversion
The Peer Teaching Society is not liable for false or misleading information…
Atrial Fibrillation
Causes:
• Hypertension
• Coronary artery disease
• Valve disease (especially mitral valve)
• Hyperthyroidism
• Infection
• Idiopathic
The Peer Teaching Society is not liable for false or misleading information…
Atrial Fibrillation
Presentation:
• Asymptomatic
• Palpitations
• Breathlessness/dyspnoea
• Dizziness/syncope
• Chest discomfort
• Stroke/TIA
The Peer Teaching Society is not liable for false or misleading information…
Atrial Fibrillation
Investigations:
• ECG
• Bloods: FBC, TFTs, LFTs, U&Es (coagulation screen)
• CXR
• Echo
The Peer Teaching Society is not liable for false or misleading information…
Atrial Fibrillation
Complications:
• Stroke/ TIA – increased six-fold
• Heart failure
• Cardiomyopathy
The Peer Teaching Society is not liable for false or misleading information…
Atrial Fibrillation
Management:
1) Rate control- beta-blockers or rate-limiting sodium channel blocker e.g.
Verapamil
2) Rhythm control- pharmacological or electrical cardioversion
- left atrial ablation
- pace and ablate strategy
3) Thromboprophylaxis- use CHA2DS2-VASc score
- warfarin therapy
- apixiban, dibigitran, rivaroxiban
Atrial Flutter• ‘saw tooth’ pattern• Atrial rates of 240-340
The Peer Teaching Society is not liable for false or misleading information…
The Peer Teaching Society is not liable for false or misleading information…
Atrial Flutter
Causes:
• Coronary heart disease
• Atrial dilatation
• Open heart surgery
• Hypertension
• COPD
• Obesity
• Thyrotoxicosis
The Peer Teaching Society is not liable for false or misleading information…
Atrial Flutter
Presentation:
• Asymptomatic
• Palpitations
• Fatigue
• Dyspnoea
• Syncope
• Heart failure
• TIA
The Peer Teaching Society is not liable for false or misleading information…
Atrial Flutter
Investigations:
• ECG
• CXR
• TFTs, FBC, ESR, U&Es, LFTs, clotting
• Echo
The Peer Teaching Society is not liable for false or misleading information…
Atrial Flutter
Management:
• Catheter radiofrequency ablation
• Electrical/Pharmacological cardioversion
• Anti-coagulants
The Peer Teaching Society is not liable for false or misleading information…
Heart Block
Types:
1) First degree = prolonged P-R interval [>200ms]
2) Second degree
3) Third degree = both present but no association between P wave and QRS complex
Mobitz I (Wenckebach) = gradual progressive P-R prolongation before a QRS complex is dropped
Mobitz II = same P-R interval followed by absent QRS complex
The Peer Teaching Society is not liable for false or misleading information…
Heart Block
First degreeMobitz I Mobitz II Third degree
a) b)
c) d)
The Peer Teaching Society is not liable for false or misleading information…
Heart Block
First degreeMobitz I
Mobitz II
Third degree
a) b)
c) d)
The Peer Teaching Society is not liable for false or misleading information…
Heart Block
Causes:
First degree:- Athletes- Myocarditis- Hypokalaemia- Hypomagnesaemia- Medications
Second degree:- Athletes- Post MI- Lyme disease- Medications
Third degree:- Complication of heart
surgery- Coronary heart
disease- Radiotherapy- Infection- Hypertension- Medications
The Peer Teaching Society is not liable for false or misleading information…
Heart Block
Symptoms
First degree:- asymptomatic
Mobitz I:- light-headedness- dizziness- syncope
Mobitz II:- chest pain- shortness of breath- tiring on exertion- postural hypotension
Third degree:- light-headedness - dizziness - fainting - fatigue (extreme tiredness) - chest pain - slow heart beat (bradycardia)
The Peer Teaching Society is not liable for false or misleading information…
Heart Block
Management:
• Transcutaneous pacing
• Pacemaker
The Peer Teaching Society is not liable for false or misleading information…
Supraventricular Tachycardia
Supraventricular = above the ventricle
• SA node overridden and another part of the heart triggers faster
impulses
Types:
• Atrio-ventricular nodal re-entry tachycardia
• Atrial tachycardia
• Wolff-Parkinson White syndrome
The heart rate must be FAST and REGULAR
The Peer Teaching Society is not liable for false or misleading information…
SVT
Atrio-ventricular nodal re-entry tachycardia
• Most common
• Seen in people aged 20-30
• Electrical short circuit in centre of the heart
• Usually no underlying cause
The Peer Teaching Society is not liable for false or misleading information…
SVT
Atrial tachycardia
• Arises from anywhere in the atria
• Usually no underlying cause
The Peer Teaching Society is not liable for false or misleading information…
SVT
Wolff-Parkinson White syndrome
• Accessory pathway between atria and ventricles
• Congenital abnormality
• May get palpitations, severe dizziness or syncope
The Peer Teaching Society is not liable for false or misleading information…
SVT
Presentation:
• Tachycardia
• Palpitations
• Dizziness
• Breathlessness
• Chest discomfort
• Asymptomatic
The Peer Teaching Society is not liable for false or misleading information…
SVT
Management:
• Self-resolving
• Adenosine
• Long term digoxin, beta-blocker, verapamil
• Catheter ablation
The Peer Teaching Society is not liable for false or misleading information…
The Peer Teaching Society is not liable for false or misleading information…
Sinus Tachycardia
Normal heart rate: 60-100bpm
Causes: • Pain• Exercise• Fever• Anxiety• Dehydration• Anaemia• Sepsis• Heart failure• Hyperthyroidism• MI• PE• Stimulant use
The Peer Teaching Society is not liable for false or misleading information…
Sinus Tachycardia
Treatment:
• Treat underlying cause
The Peer Teaching Society is not liable for false or misleading information…
Questions
A 51 year old gentleman is complaining of palpitations. He is a smoker and
you find his blood pressure is 145/92. He has an underactive thyroid for
which he take Levothyroxine. His ECG shows an irregularly irregular
rhythm.
Name this condition………………………………………What his main risk factor for developing this?………………………………………….What is the first line treatment of this condition?………………………………………….Give the class of drug suitable for this…………………………………………Give a complication of this condition?..........................................................
The Peer Teaching Society is not liable for false or misleading information…
Questions
A man comes into hospital looking very unwell. His vital signs are: -Temp :39.5- SpO2 : 95% on air- BP: 110/65- HR: 135bpmHe is found to have a pneumonia causing sepsis
List 4 other cause of sinus tachycardia………………………………………………..………………………………………………...………………………………………………..……………………………………………….
The Peer Teaching Society is not liable for false or misleading information…
Questions
You are asked to review a ECG of a lady admitted to your ward. You notice that the P-R interval is irregular and that after every now and then there is an absent QRS complexYou diagnose heart block
Which type of heart block does she have?…………………………………………………………
Give 2 symptoms that she might be experiencing………………………………………………………….
What treatment does she require?………………………………………………………….