Nikita Goyal; CVS
Disorders of Heart Rate and Rhythm
Info History/RF Examination Investigation Management
Bradyarrhythmias <60bpm
Sinus bradycardia Ax - Physical fitness; Extrinsic - Syncope Pulse rate Bedside – ECG – Low HR If asymptomatic – no treatment
Heart rate of less Hypothermia, hypothyroidism Pre-syncope – <60bpm Bloods- Acute
than 60bpm in Drugs ➙ digoxin toxicity, beta blockers; dizziness, sweaty, pale Abnormal HS FBE, UEC DRSABCDE; give O2 if hypoxic
adults Intrinsic - Sick sinus syndrome - Fatigue Oedema Trop, CK Atropine – inverse M agonist
Mediated by an degeneration or fibrosis of the SA/sinus Confusion Hypotension TFT Transcutaneous pacing – delivers pulses
increase in PSNS node Dyspnoea Digoxin lvl of electric current through the pts chest
tone Acute ischaemia or infarction Imaging – Holter, Echo stimulating heart to contract
AV Block Ax – ischaemia/infarction, sarcoidosis, Syncope Same as above Asymptomatic - monitor and address
Delayed amyloidosis, IE, BB, digoxin, CCB Pre-syncope – Bedside - ECG complications
conduction 1st degree – CAD, digoxin toxicity, dizziness, sweaty, pale 1st Degree – PR interval > 5ss; All Symptomatic
between atria and electrolyte disturbances Fatigue QRS complexes have a P wave Haemodynamically stable – monitor
ventricles 2nd degree – athletes, CAD, myocarditis, Confusion 2nd Degree Type 1 – PR interval Haemodynamically unstable –
rheumatic carditis, digoxin toxicity, Dyspnoea gradually becomes longer before Atropine
electrolyte disturbances QRS drops Temporary/ Transcutaneous pacing –
3rd degree – Acute – MI; Chronic – 2nd degree Type 2 – PR interval attach electrodes to chest and shock their
Bundle of His fibrosis; L/R BBB long, but stable before QRS test on every beat
complexes Isoprenaline or adrenaline
3rd degree – no relationship b/w Permanent pacemaker
P waves and QRS complexes
BBB Ax Syncope Same as above Cardiac resynchronisation pacemaker
Signal from AV Fibrosis - ischaemia, myocarditis, HTN, Pre-syncope – Bedside - ECG –
node gets blocked CAD, CM dizziness, sweaty, pale Widened QRS complex as
through bundle LBB – New->AMI until proven Fatigue depolarization becomes longer
branches otherwise; IHD, CM, HTN, Aortic Confusion LBBB – W morphology of QRS in
stenosis Dyspnoea V1 (rS); M (WiLLiaM)
RBB – Can be normal, PE, pacing wires, morphology of QRS in V6 (RsR)
right sided AMI RBBB – M morphology of QRS in
V1 (rSR); W shape in QRS of V6
(qRs) (MaRRoW)
Sinus Tachycardia Ax – Physiological – exercise, panic, Tachycardia Skin pallor Reverse underlying causes – infection,
>100bpm anxiety, fever; Pathological – anaemia, Palpitations Lid lag + hyperthyroidism
PE, thyrotoxicosis, sepsis, hypotension, SOB clammy skin Manage comps
decompensated HF; Phar, - beta Hypotension
agonists, sympathomimetics, anti- +/- Pharm – metoprolol, CCBs
muscarinic, caffeine orthostatic
nature
Supraventricular
Tachyarrhythmias
Disorders of Heart Rate and Rhythm
Info History/RF Examination Investigation Management
Bradyarrhythmias <60bpm
Sinus bradycardia Ax - Physical fitness; Extrinsic - Syncope Pulse rate Bedside – ECG – Low HR If asymptomatic – no treatment
Heart rate of less Hypothermia, hypothyroidism Pre-syncope – <60bpm Bloods- Acute
than 60bpm in Drugs ➙ digoxin toxicity, beta blockers; dizziness, sweaty, pale Abnormal HS FBE, UEC DRSABCDE; give O2 if hypoxic
adults Intrinsic - Sick sinus syndrome - Fatigue Oedema Trop, CK Atropine – inverse M agonist
Mediated by an degeneration or fibrosis of the SA/sinus Confusion Hypotension TFT Transcutaneous pacing – delivers pulses
increase in PSNS node Dyspnoea Digoxin lvl of electric current through the pts chest
tone Acute ischaemia or infarction Imaging – Holter, Echo stimulating heart to contract
AV Block Ax – ischaemia/infarction, sarcoidosis, Syncope Same as above Asymptomatic - monitor and address
Delayed amyloidosis, IE, BB, digoxin, CCB Pre-syncope – Bedside - ECG complications
conduction 1st degree – CAD, digoxin toxicity, dizziness, sweaty, pale 1st Degree – PR interval > 5ss; All Symptomatic
between atria and electrolyte disturbances Fatigue QRS complexes have a P wave Haemodynamically stable – monitor
ventricles 2nd degree – athletes, CAD, myocarditis, Confusion 2nd Degree Type 1 – PR interval Haemodynamically unstable –
rheumatic carditis, digoxin toxicity, Dyspnoea gradually becomes longer before Atropine
electrolyte disturbances QRS drops Temporary/ Transcutaneous pacing –
3rd degree – Acute – MI; Chronic – 2nd degree Type 2 – PR interval attach electrodes to chest and shock their
Bundle of His fibrosis; L/R BBB long, but stable before QRS test on every beat
complexes Isoprenaline or adrenaline
3rd degree – no relationship b/w Permanent pacemaker
P waves and QRS complexes
BBB Ax Syncope Same as above Cardiac resynchronisation pacemaker
Signal from AV Fibrosis - ischaemia, myocarditis, HTN, Pre-syncope – Bedside - ECG –
node gets blocked CAD, CM dizziness, sweaty, pale Widened QRS complex as
through bundle LBB – New->AMI until proven Fatigue depolarization becomes longer
branches otherwise; IHD, CM, HTN, Aortic Confusion LBBB – W morphology of QRS in
stenosis Dyspnoea V1 (rS); M (WiLLiaM)
RBB – Can be normal, PE, pacing wires, morphology of QRS in V6 (RsR)
right sided AMI RBBB – M morphology of QRS in
V1 (rSR); W shape in QRS of V6
(qRs) (MaRRoW)
Sinus Tachycardia Ax – Physiological – exercise, panic, Tachycardia Skin pallor Reverse underlying causes – infection,
>100bpm anxiety, fever; Pathological – anaemia, Palpitations Lid lag + hyperthyroidism
PE, thyrotoxicosis, sepsis, hypotension, SOB clammy skin Manage comps
decompensated HF; Phar, - beta Hypotension
agonists, sympathomimetics, anti- +/- Pharm – metoprolol, CCBs
muscarinic, caffeine orthostatic
nature
Supraventricular
Tachyarrhythmias
