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Presents @BRITISHINDIANMEDICASSOCIATION @BIMA @BINDIANMEDICSHaileyOng FoundationYear 1 Doctor Currently working in Severn Deanery Graduate of University of GlasgowACUTEANDCHRONICARRHYTHMIASIDENTIFYING ARRHYTHMIAS 1. Does the ECG look funny? Arrhythmia 2. Is the rate fast or Bradyarrhythmia Tachyarrhythmia 60 bpm 0bp m slow? < >10 Heart Block Narrow Complex Broad Complex 3. Are there p waves? PR prolonged <120m s >1 20ms Q RS QR S 4. What does the 1st 2ndDegree Complete AF AFlutter VTach VFib Degree Some drops QRS look like? s No in No drp Mobitz Mobitz crrlat type 1 type 2 5. What meds should ATROPINE ADENOSINE AMIODARONE you consider using?IDENTIFYING ARRHYTHMIASIDENTIFYING ARRHYTHMIASIDENTIFYING ARRHYTHMIASIDENTIFYING ARRHYTHMIASIDENTIFYING ARRHYTHMIASIDENTIFYING ARRHYTHMIASIDENTIFYING ARRHYTHMIASIDENTIFYING ARRHYTHMIASIDENTIFYING ARRHYTHMIASWHY THOSE DRUGS? ATROPINE ADENOSINE AMIODARONE Anti-muscarinic, stops PNS Reduces Ca2+ influx into SA K+ channel blocker of cardiac stimulation of heart node cells, delay AP in SA nomyocytes, prolongs contraction, prevents repolarization. Prevents the ‘rest and digest’Works on atrial origins of Works on ventricular origins of response arrhythmia arrhythmiaWHEN SHOULD WE USE THOSE DRUGS? BRADYARRHYTHMIAS TACHYARRHYTHMIAS Is this patient haemodynamically stable? Is this person imminently going into deteriorate? ADVERSE SIGNS: 1. SHOCK 2. SYNCOPE 3. HEART FAILURE 4. MYOCARDIAL ISCHAEMIA What’s the fastest What’s the fastest DC CARDIOVERSION / ATROPINE way to speed it up? way to slow it down?DEFIBRILLATIONTREATING AFCONSIDERING ANTICOAGULATION 2 or more s vSBA 1 The ECG below is taken from a 78-year-old woman who had been experiencing palpitations for the past two days: WHAT DOES THIS ECG SHOW? b. Atrial flutter with variable block c. Supraventricular tachycardia d. Polymorphic ventricular tachycardia e. Atrial Fibrillation BSBA 2 A 58-year-old man presents with breathlessness and chest discomfort. He has diet controlled diabetes, hypertension and hyperlipidaemia. He has a weak rapid, regular pulse of 160bpm, blood pressure is 80/50mmHg, he is cold peripherally and crepitations are heard bibasally on auscultation of the chest. An ECG shows a regular broad complex tachycardia. What is the best initial management of this arrhythmia? a. Adenosine b. Amiodarone d. Electrical cardioversion e. Vagal manoeuvres DSBA 3 A 55-year-old female presents to the emergency department with an eight-hour history of heart palpitations. She has a heart rate of 200 beats per minute and an ECG shows regular QRS complexes of 0.08 seconds. She has not had any chest pain or episodes of syncope and has no signs of heart failure. Her blood pressure is 130/90 mmHg and her oxygen saturations are 97% on air. What should you do first? a. Carotid sinus massage c. Adenosine 12mg d. Amiodarone 300mg e. Atropine 0.5mg ASBA 4 A 44-year-old woman presents to the emergency department with dyspnoea. She has been feeling intermittently dizzy and short-of-breath for the past 2 weeks. On examination her pulse is 180/min, blood pressure 100/66 mmHg, oxygen saturations 98% on room air. Her chest is clear and she appears well perfused. An ECG is obtained: What is the most appropriate treatment: a. IV amiodarone b. IV adenosine d. IV labetolol sulphate e. unsynchronised DC shock ESBA 5 An elderly patient in the respiratory ward has a cardiac arrest. You start compressions and the resuscitation team are contacted. Assessment of the rhythm shows ventricular fibrillation (VF). What is the next course of action? a. Administer 1mg adrenaline IV with compressions at a rate of 30:2 b. Administer 300mg amiodarone IV with compressions c. Synchronised DC cardioversion at 130 joules d. Synchronised DC cardioversion at 300 joules e. Continue compressions at a rate of 30:2 and then use the defibrillator at 150 joules ESBA 6 You are called to see a patient by the nurse on your night shift. The patient is a 74- year-old gentleman whose heart rate has suddenly increased to 154 beats/minute. His blood pressure is 130/83 mmHg, his respiratory rate is 18 breaths/minute. He is otherwise feeling well. You order an ECG. The ECG shows a narrow complex tachycardia with left heart strain. There is no ST segment elevation or T wave depression. What is the initial management of this patient? a. Electrical cardio version c. Oral beta-blocker d. IV beta-blocker e. Valsalva manoeuvre ESBA 7 A 79yr old man presents with a 1 day history of palpitations and light headedness. He states he has had similar episodes over the last few years, but they always went away after a short time. His BP is 146/81, and pulse rate 120bpm. Chest is clear, heart sounds normal. There is no peripheral oedema. He has a PMH of: IHD, HTN and gout. He is normally fit and well. ECG shows an irregularly irregular rhythm, with no clear p waves. There are no obvious signs of ischaemia. Bloods and CXR grossly normal. What is the most suitable initial treatment for this man’s presentation? a. Aspirin 300mg and clopidogrel 300mg c. Bisoprolol 2.5mgograms d. Apixaban 5mg twice daily e. Electrical cardioversion C THANK Y OU FOR LISTENING! FEEDBACK FORM Pattendance and for the slidesrtificate of