cardiac arrhythmias

v.djabatey
Mind Map by , created over 5 years ago

Paediatrics (Cardio) Mind Map on cardiac arrhythmias, created by v.djabatey on 01/29/2014.

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Created by v.djabatey over 5 years ago
persistent ductus arteriosus
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outflow obstruction in sick infant
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rheumatic fever
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History GCSE AQA B: Modern World History - International Relations: Conflict and Peace in the 20th Century - Topic 2: Peacemaking 1918-19 and the League of Nations
mariannakeating
Core 1.8 Metals
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infective endocarditis
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Presentation of congenital heart disease
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Hereditary Haemogenous Telangiectasia
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Circulatory changes at birth
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Eisenmenger syn
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cardiac arrhythmias
1 sinus arrhythmia
1.1 normal in kids
1.2 detected as cyclical change in heart rate w/ respiration
1.2.1 acceleration during inspiration & slowing on expiration
1.2.1.1 heart rate changes by up to 30 beats/min
2 supraventricular tachycardia
2.1 commonest childhood arrhythmia
2.2 rapid heart rate
2.2.1 250-300 beats per min
2.3 ->
2.3.1 poor cardiac output
2.3.2 pulmonary oedema
2.4 presents w/ sx of heart failure in neonate or young infant
2.4.1 often ppted by febrile illness
2.4.2 sudden onset & cessation
2.4.2.1 lasts seconds to hours
2.5 can cause
2.5.1 hydrops fetalis
2.5.2 intrauterine death
2.6 re-entry tachycardia
2.6.1 circuit of conduction set up
2.6.1.1 w/ premature activation of atrium via an accessary pathway
2.6.2 rarely structural prob is origin
2.6.2.1 but must do echo
2.7 Ix
2.7.1 ECG
2.7.1.1 narrow complex tachycardia
2.7.1.1.1 of 250-300 beats per min
2.7.1.2 may see P wave after QRS complex
2.7.1.2.1 due to retrograde activation of atrium via accessory pathway
2.7.1.3 if severe heart failure
2.7.1.3.1 changes suggestive of myocardial ischaemia may be seen
2.7.1.3.1.1 T wave inversion in lateral precordial leads
2.7.1.4 when in sinus rhythm
2.7.1.4.1 short P-R interval may be detected
2.7.1.4.1.1 Wolf Parkinson White syn
2.7.1.4.1.1.1 short P-R interval & delta wave
2.7.1.4.1.1.1.1 to early antegrade activation of ventricle via the pathway
2.7.1.4.1.1.2 pre-excitation sn predisposing to SVT
2.7.1.4.1.1.3 due to abnormal re-entry circuit btw AVN & accessory pathway connecting atrium to ventricle
2.7.1.4.1.1.3.1 within interventricular septum or on right or left lateral cardiac border
2.7.1.4.1.1.4 assoc w/
2.7.1.4.1.1.4.1 Ebstein's anomaly
2.7.1.4.1.1.4.2 post surgical repair
2.7.1.4.1.1.4.3 cardiomyopathy
2.8 Mx
2.8.1 aim= prompt restoration of sinus rhythm
2.8.1.1 circulatory & respiratory support
2.8.1.1.1 correct tissue acidosis
2.8.1.1.2 +ve Pa ventilation if needed
2.8.1.2 vagal stimulation manoeuvres
2.8.1.2.1 carotid massage
2.8.1.2.2 cold ice pack to face
2.8.1.2.3 works in 80% of cases
2.8.1.3 iv adenosine
2.8.1.3.1 Rx ofchoice
2.8.1.3.2 safe & effective
2.8.1.3.3 induces AV block after rapid bolus injection
2.8.1.3.3.1 ends tachycardia by breaking re-entry circuit set up btw AVN & accessory pathway
2.8.1.3.4 given incrementally in increasing doses
2.8.1.4 if adenosine fails
2.8.1.4.1 electrical cardioversion w/ a synchronised shock
2.8.1.4.1.1 0.5-2J.kg body weight
2.8.2 once sinus rhythm restored
2.8.2.1 maintenance needed
2.8.2.1.1 flecainide
2.8.2.1.2 sotalol
2.8.2.1.3 digoxin
2.8.2.1.3.1 used alone when no pre-excitation wave (delta wave) on ECG
2.8.2.1.3.2 + propanolol
2.8.2.1.3.2.1 if delta wave present on ECG
2.8.3 Rx stopped at 1 year old
2.8.3.1 90% of kids have no further attacks after infancy
2.8.3.1.1 but ECG remains abnormal
2.8.4 WPW syn
2.8.4.1 quick assessment
2.8.4.1.1 to ensure can't conduct quickly
2.8.4.1.2 w/ atrial pacing
2.8.4.1.2.1 in teens
2.8.4.1.2.2 reduce chance of sudden death
2.8.5 (risk of) relapse
2.8.5.1 target accessory pathway
2.8.5.1.1 radiofreq ablation
2.8.5.1.2 cryoablation
3 congenital complete heart block
3.1 rare
3.2 related to presence of anti-Ro/anti-La antibodies in maternal serum
3.2.1 these mums will have manifest/latent connective tissue disorders
3.2.1.1 subseq pregnancies affected
3.2.2 prevents normal development of electrical conduction sys in developing heart
3.2.2.1 atrophy & fibrosis of AVN
3.3 can cause
3.3.1 fetal hydrops
3.3.2 death in utero
3.3.3 neonatal heart failure
3.4 most are asymp for many years
3.5 can be symptomatic
3.5.1 presyncope
3.5.2 syncope
3.5.3 if so need endocardial pacemaker
4 other arrhythmias
4.1 long QT syn
4.1.1 sudden loss of consciousness
4.1.1.1 during
4.1.1.1.1 exercise
4.1.1.1.2 stress
4.1.1.1.3 emotion
4.1.2 differential
4.1.2.1 epilepsy
4.1.3 usually in late childhood
4.1.4 if unrecognised
4.1.4.1 sudden death from ventricular tachycardia can occur
4.1.5 autosomal dominant inheritance
4.1.6 assoc w/
4.1.6.1 erythromycin therapy
4.1.6.2 electrolyte disorders
4.1.6.3 head injury
4.1.7 part of channelopathies
4.1.7.1 caused by specific gene mutations
4.1.7.2 abnormalities of Na+, K+ or Ca2+ channels -> gain/loss of function
4.1.8 assess anyone w/
4.1.8.1 fam hx of sudden unexplained death
4.1.8.2 hx of syncope on exertion
4.2 rare
4.2.1 often seen in kids who've had surgery for complex congenital heart disease
4.2.1.1 atrial fibrillation
4.2.1.2 atrial flutter
4.2.1.3 ectopic atrial tachycardia
4.2.1.4 ventricular tachycardia
4.2.1.5 ventricular fibrillation

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