Cardiovascular 2 Phase 2 Michelle Mair The Peer Teaching Society is not liable for false or misleading information…

Aims 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…

ECGs The Peer Teaching Society is not liable for false or misleading information…

1) Heart Rate 2) Heart Rhythm 3) Cardiac axis 4) P waves 5)P-R interval 6) QRS complex 7) ST segment 8) T waves The Peer Teaching Society is not liable for false or misleading information…

Cardiac axis Normal Axis Positive AVR AVL Positive I Positive II III AVF Positive Positive The Peer Teaching Society is not liable for false or misleading information…

Cardiac axis Right Axis Deviation Negative AVR AVL Positive I Positive II III AVL AVR AVF Positive Positive The Peer Teaching Society is not liable for false or misleading information…

Cardiac axis Left Axis Deviation Positive AVR AVL I Negative Negative II III AVL AVR AVF Negative Negative The Peer Teaching Society is not liable for false or misleading information…

Irregularly irregular rhythm Varying rate Absent p waves 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: Paroxysmal= spontaneous termination within 7 days, most commonly in 48 hours Persistent= not self-limiting, lasting longer than 7 days or prior to cardioversion 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: Rate control- beta-blockers or rate-limiting sodium channel blocker e.g. Verapamil Rhythm control- pharmacological or electrical cardioversion - left atrial ablation - pace and ablate strategy 3) Thromboprophylaxis- use CHA2DS2-VASc score - warfarin therapy - apixiban, dibigitran, rivaroxiban The Peer Teaching Society is not liable for false or misleading information…

Atrial Flutter ‘saw tooth’ pattern Atrial rates of 240-340 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: First degree = prolonged P-R interval [>200ms] Second degree 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 degree Mobitz I Mobitz II Third degree b) a) c) d) The Peer Teaching Society is not liable for false or misleading information…

Heart Block a) b) Third degree Mobitz II d) c) First degree Mobitz I 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 The heart rate must be FAST and REGULAR Types: Atrio-ventricular nodal re-entry tachycardia Atrial tachycardia Wolff-Parkinson White syndrome 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: 135bpm He 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 complex You diagnose heart block Which type of heart block does she have? ………………………………………………………… Give 2 symptoms that she might be experiencing …………………………………………………………. What treatment does she require? The Peer Teaching Society is not liable for false or misleading information…