Arrhythmias

Question 1

P mitrale

Answer 1

Consequence of left atrial enlargement (usually mitral stenosis)

Question 2

P pulmonale

Answer 2

Consequence of right atrial enlargement (often a consequence of pulmonary stenosis or pulmonary hypertension)

Question 3

Patient presents with supraventricular tachycardia.

What is the first step?

Answer 3

Adenosine challenge

This has the chance to reverse AVRT, AVNRT, and WPW

Question 4

Common drugs used to treat supraventricular tachycardias (non-adenosine drugs)

Answer 4

• Beta blockers
• Diltiazem
• Digoxin

Note: Contraindicated in WPW

Question 5

Drugs of choice in WPW syndrome

Answer 5

• Adenosine
• Procainamide (Type 1c antiarrhythmic)
• Amiodraone (Type 3 antiarrhythmic with Type 1, 2, 4 properties)

Question 6

Contraindications to adenosine in management of SVT

Answer 6

Bronchospasm

Asthma

COPD

Question 7

Typical SVT

Answer 7

160-180 bpm with a rapid, regular rhythm

Narrow complexes

Late p wave visualized in the final portion of the QRS complex with retrograde P wave conduction.

Responds to adenosine

Question 8

Typical atrial flutter

Answer 8

240-350 bpm atrial rate

75, 100, or 150 bpm (1:2, 1:3, 1:4) ventricular rate

“Sawtooth” P waves

Question 9

Rhythm control medications for atrial fibrillation

Answer 9

If structural disease is present: Amiodarone or dronedarone

If there is no structural disease: Propafenone or flecainide

Question 10

Sick sinus syndrome

Answer 10

Variable sinus bradycardia, sinus pause, sinus tachycardia, and sinus block. Frequently associated with SVTs, especially atrial fibrillation and flutter

Treat with atropine acutely if there is symptomatic bradycardia.

Internal pacing is the mainstay of long-term therapy.

Question 11

Drugs of choice for acute, sustained, monomorphic ventricular tachycardia (if using pharmacologic therapy)

Answer 11

Lidocaine, procainamide, or amiodarone

Question 12

Drugs of choice for ventricular tachycardia in a patient with structural heart disease or congenital long QT syndrome

Answer 12

Procainamide

Question 13

Drug of choice for ventricular tachycardia in acquired long QT

Answer 13

IV magnesium

Question 14

Brain death is likely if return of spontaneous circulation does not occur within ___ of the onset of ventricular tachycardia

Answer 14

Brain death is likely if return of spontaneous circulation does not occur within 90 seconds of the onset of ventricular tachycardia

Question 15

Anyone with a tachyarrhythmia and unstable hemodynamics gets. . .

Answer 15

. . . immediate electrical cardioversion

Question 16

The younger the patient with an arrhythmia, the more likely. . .

Answer 16

. . . that a congenital accessory pathway is present

Question 17

Patients with persistent ventricular tachycardia and structural heart disease are ideally treated with. . .

Answer 17

. . . an implantable cardiac defibrillator (ICD)