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Last updated on 23 Jul 2015 at 3:51 PM (CVS06)
Arrhythmias
A 64 year old NZ European man is brought to the Emergency Department by
ambulance. He had collapsed, temporarily lost consciousness and was observed to
become pale at the time of collapse. When the ambulance crew arrived, it was noted
that his pulse rate was very rapid.
Applied Science for Medicine
Structure of cardiac myocytes
Normal cardiac electrophysiology including ion channel activity during
cardiomyocyte depolarization
Normal ECG and how it correlates with the cardiac cycle; how a 12 level ECG is
generated from 10 leads; calculate the QTc interval
Principles of drug distribution, metabolism and excretion; concentration-time
relationships, individual variability in response to drugs; pharmacogenetic variability;
monitoring drug therapy, drug interactions, rational approach to prescribing
Vaughan-Williams classification of anti-arrhythmic drugs
Pharmacology of amiodarone, sotalol, lignocaine and membrane stabilisers, warfarin
Clinical and Communication Skills
History from a patient or witness following a syncopal episode; indication for
hospital admission
Take a thorough medication history
Examination of a patient post syncope; recognise signs of haemodynamic
compromise
Perform an ECG; identify atrial fibrillation and flutter, supraventricular tachycardia,
left and right bundle branch block, ventricular tachycardia and fibrillation, WolffParkinson-White syndrome, first-, second type 1-, second type 2- and third-degree
heart blocks, atrial and ventricular ectopy
Indications for Holter monitor, echocardiogram, cardiac MRI, electrophysiology
studies
Differential diagnosis of syncope
Causes of narrow complex and broad complex tachycardias
Pharmacological and non-pharmacological management of tachyarrhythmias and
bradyarrhythmias
Management of atrial fibrillation: rate vs rhythm control, use of anticoagulation;
preparation required for elective cardioversion
Role of the anticoagulant clinic and pharmacist
Complications of atrial fibrillation
Management of pulseless ventricular tachycardia and ventricular fibrillation
Indications for, and methods of cardioversion
Prescribe drugs safely, effectively and economically; write prescriptions that take
into account the needs of individual patients; prescribe high risk medications (e.g.
warfarin)
Personal and Professional Skills
Taking a collateral history
Competence and decision-making
Patient education, including anticoagulant counselling
Population Health
Epidemiology of syncope and atrial fibrillation
Epidemiology of stroke in those with atrial fibrillation
Access to healthcare resources: implantable defibrillators
Conditions to be considered relating to this scenario
vasovagal syncope, heart block (first, second and thirdCommon
degree), sustained and non-sustained ventricular
tachycardia, AV nodal re-entrant tachycardia, AV
reentrant tachycardia, Stokes-Adams attack, orthostatic
hypotension, hypoglycaemia, drug induced, aortic
stenosis, atrial fibrillation, mitral stenosis, emotional
trauma
vertebrobasilar artery TIA, Wolff-Parkinson-White
Less common but
syndrome, ruptured abdominal aortic aneurysm,
'important not to miss'
hypertensive encephalopathy, epilepsy, Brugada
syndrome, polymorphic ventricular tachycardia,
subarachnoid haemorrhage, hypertrophic obstructive
cardiomyopathy
tachy-brady syndrome, sick sinus syndrome, multifocal
Uncommon
atrial tachycardia, subclavian steal syndrome