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Phase 2 Michelle Mair

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.

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Phase 2 Michelle Mair

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

  2. 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…

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

  4. 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…

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

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

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

  8. Atrial Fibrillation • Irregularly irregular rhythm • Varying rate • Absent p waves • The Peer Teaching Society is not liable for false or misleading information…

  9. 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…

  10. 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…

  11. 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…

  12. 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…

  13. Atrial Fibrillation • Complications: • Stroke/ TIA – increased six-fold • Heart failure • Cardiomyopathy • The Peer Teaching Society is not liable for false or misleading information…

  14. 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…

  15. Atrial Flutter • ‘saw tooth’ pattern • Atrial rates of 240-340 • The Peer Teaching Society is not liable for false or misleading information…

  16. 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…

  17. Atrial Flutter • Presentation: • Asymptomatic • Palpitations • Fatigue • Dyspnoea • Syncope • Heart failure • TIA • The Peer Teaching Society is not liable for false or misleading information…

  18. 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…

  19. Atrial Flutter • Management: • Catheter radiofrequency ablation • Electrical/Pharmacological cardioversion • Anti-coagulants • The Peer Teaching Society is not liable for false or misleading information…

  20. 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…

  21. 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…

  22. 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…

  23. Heart Block • Causes: • First degree: • Athletes • Myocarditis • Hypokalaemia • Hypomagnesaemia • Medications • Third degree: • Complication of heart surgery • Coronary heart disease • Radiotherapy • Infection • Hypertension • Medications • Second degree: • Athletes • Post MI • Lyme disease • Medications • The Peer Teaching Society is not liable for false or misleading information…

  24. Heart Block Symptoms Firstdegree: - 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…

  25. Heart Block • Management: • Transcutaneous pacing • Pacemaker • The Peer Teaching Society is not liable for false or misleading information…

  26. 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…

  27. 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…

  28. 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…

  29. 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…

  30. SVT • Presentation: • Tachycardia • Palpitations • Dizziness • Breathlessness • Chest discomfort • Asymptomatic • The Peer Teaching Society is not liable for false or misleading information…

  31. 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…

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

  33. 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…

  34. Sinus Tachycardia • Treatment: • Treat underlying cause • The Peer Teaching Society is not liable for false or misleading information…

  35. 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…

  36. 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…

  37. 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…

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