CARDIOLOGY
CARDIOLOGY
Embedded Files
ARRHYTHMIAS
ARRHYTHMIAS
ABOUT THIS SESSION
ABOUT THIS SESSION
This is a self-directed learning resource designed to be worked through in the clinical environment.
Learning objectives:
Learning objectives:
Recognise common presentations of arrythmias
Systematically interpret ECGs and recognise common arrhythmias
Understand initial, emergency management of potentially unstable arrhythmias according to advanced life support algorithms
Understand principles of management of atrial fibrillation
Total time:
60 minsNumber of students:
1-2Grade of students:
3rd to 5th year medical studentsCreated by:
Dr Charlotte HaydenUploaded:
27th August 2020Last updated:
27th August 2020Resources needed for this session:
Resources needed for this session:
Patient, pen, paper, drug chart
Resources linked to this session:
Resources linked to this session:
none
Activity 1: History Taking and Examination
20 minActivity 1: History Taking and Examination
Identify a suitable patient presenting with syncope, palpitations or a proven arrhythmia. Take a focused history from the patient to include presenting complaint, history of presenting complaint, past medical, drug, social and family history. Remember to ask about any key risk factors for arrhythmias.
Perform a focused cardiovascular examination on the patient, in addition to any other examinations you feel are appropriate.
Activity 2: Documentation and Diagnostic Reasoning
5 minActivity 2: Documentation and Diagnostic Reasoning
Document your findings in a systematic manner. You may want to use a local clerking proforma or have a look at this useful summary from Geeky Medics.
Write down 3-5 key differential diagnoses, with the most likely at the top. From this list, suggest one or two key features from the history and/or examination that makes each more and less likely.
What initial investigations will help you confirm and differentiate between these diagnoses?
Activity 3: Bedside Tests
5 minActivity 3: Bedside Tests
Find the patient’s admission ECG. Using a systematic approach, see if you can identify any abnormalities.
Things to consider:
Is the patient in normal (sinus) rhythm? What are the key features that support your choice.
If not in sinus rhythm, what rhythm is most likely and why?
If in sinus rhythm, are there any clues that the patient has had a recent arrhythmia? What might these be?
Activity 4: Management
25 minActivity 4: Management
Find the Resuscitation Council UK ALS Algorithm for peri-arrest arrhythmias. If the patient you have seen has had a confirmed arrhythmia, review their management and compare it to the algorithm.
If the patient you have seen has not had a confirmed arrhythmia, work through the following case studies and decide the best treatment for the patient using the Resuscitation Council UK guidelines.
Case 1
Case 1
A 59-year-old patient with palpitations presents to the emergency department. He feels lightheaded and sweaty, but denies chest pain. He was recently treated for a STEMI around 2 weeks ago and other past medical history includes hypertension and type two diabetes. On examination, his heart rate is 150 bpm, blood pressure 85/43 mmHg, oxygen saturations 95% on air. His ECG is shown opposite.
What does the ECG show?
What is the most appropriate initial management?
Case 2
Case 2
A 28-year-old patient with palpitations is seen in the emergency department. He is alert, responsive, and denies any chest pain or light-headedness. He has no relevant past medical history. On examination his heart rate is 220 bpm regular, blood pressure 110/62 mmHg, oxygen saturations 98% on air. His ECG is shown opposite.
What does the ECG show?
What is the most appropriate initial management for this patient?
What would be the next steps if your initial management was not successful?
How would your management differ if his blood pressure was 80/40 mmHg?
Case 3
Case 3
A 70-year-old woman presents with an episode of cardiac syncope witnessed by her daughter. She reports no prodromal symptoms but suddenly ‘blacked out’ whilst sat eating her lunch. She has no medical history of note. An ECG on admission is normal, but she suffers a further episode of syncope whilst you are examining her. A current ECG is shown opposite.
What does the ECG show?
Given the clinical information above, what is your initial management?
How should she be monitored once this episode resolves?
What is the difference between simple cardiac monitoring and telemetry?
What are the indications for a pacemaker?
Case 4
Case 4
An 80-year-old woman presents to her GP for a routine follow-up appointment one month following a stroke. She walked into the consulting room and denies any chest pain or palpitations. Her past medical history includes hypertension and congestive cardiac failure. She lives alone independently and walks unaided. An ECG is taken and is shown opposite.
What does the ECG show?
What management options are there for this lady’s arrhythmia?
What is her risk of another stroke?
How should this risk be minimised?
Activity 5: Further Management
5 minActivity 5: Further Management
Consider:
How can a patient with a suspected arrhythmia be investigated as an outpatient?
If your hospital has an arrhythmia clinic, find the referral criteria and if possible, attend the clinic to consolidate your knowledge of arrhythmias.
Summary and Feedback
5 minSummary and Feedback
Highlight three key things you have learned today. Summarise them on a post-it note and keep it somewhere you will find in a week or two.
Found this useful? Please leave some feedback.
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