Arrthymias

Question 1

Management of AF: Step 1

Answer 1

Unstable? (BP, angina, edema)

YES = cardioversion
-AC: hep 60/12, lmwh
-4 weeks oral AC

NO = control AVN
-DHF = amio, digoxin (DAD)
-NO DHF = EDMV
-AC: hep, lmwh

Question 2

Management of AF: Step 2 (SR or VRC)

Answer 2

RATE
-LVEF > 40: DMV +/- digoxin
-LVEF < 40: MC +/- digoxin
+AC

RHYTHM
*AF 48 hr+?
-YES = 3-6 wk AC, TEE
-NO = continue heparin, lmwh
or
*Elec conv: Js
*Pharm conv:
-HFrEH, LV < 40: amio
-N LV: PIA
-N LV O: PF
then
-4 weeks AC

Question 3

Management of AF: Step 3 (prevention)

Answer 3

Maintain NSR
Normal
-DD FP AS
MI/SHD/<40
-DADS

Prevent Stroke
Use CHADS score
-Low (0/1): can omit
-Int (1/2): consider WARED
-High (2/3): WARED

VALVULAR AF = WARFARIN

Question 4

PSVT Etiology/SX

Answer 4

ET
-Hyperthyroidism
-Caffeine, nic, alc, drugs
-Anxiety
-MI, myocarditis
-PE, hypoxia

< 0.12 is psvt

SX
-Chest tightness
-Palpitations
-SOB
-Dizzy, fainting

Question 5

PSVT: TX

Answer 5

1. Vagal maneuvers + IV adenosine
2. Stable?
   -YES = Meto/Dilt
   *AVRT = Joules
   *AVNRT = IV amiodarone then Joules
   -NO = Joules

Question 6

Vagal Maneuvers

Answer 6

1. Valsalva maneuver
2. Carotid massage
3. Ice water facial
4. Induce retching

Question 7

Is prophylactic therapy needed to prevent PSVT recurrence?

Answer 7

YES, if frequent episodes or severe sx

AAD Options
-Amiodarone
-BB
-Dofetilide
-Flecainide
-CCD, VD
-Propafenone
-Sotalol

ABCD PSF

Question 8

Ventricular Tachycardia

Answer 8

WIDE complex

QRS 0.12+ seconds

Question 9

Monomorphic, stable Ventricular Tachycardia: TX

Answer 9

With SHD
-Procainamide
-Amiodarone
-Sotalol
-Mg if TDP suspected
(SPAM)

Without SHD
-Verapamil or BB
(BV)

BV and monos are a SPAM

Question 10

Treatment of Chronic, Recurrent, Sustained VT

Answer 10

Amiodarone, Sotalol

Question 11

Treatment of Nonsustained Ventricular Tachycardia

Answer 11

-Conservative: BBs
-Empiric Amiodarone
-Aggressive: electrophysiologic

Question 12

Torsades de Pointes

Answer 12

Unstable = cardioversion

Stable =
-K to high-normal values of 4.5-5
-Mg Sulfate 2 g IV, can repeat 5-15 min later, then repeat Q6 hr if > 500 QTc

Secondary Tx
-Isoproterenol
-Transvenous pacing

Question 13

Bradyarrhythmias

Answer 13

-Avoid drugs used in SVTs
-Caution with BB/CCBs

Question 14

AV Block: TX

Answer 14

Acute, sx: immediate transcutaneous pacing

-Atropine 1 mg IV Q5 min (max 3 mg)
-Epi or Dopamine 2-10 mcg/min
-Isoproterenol 2-10 mcg/min (if no response to ED)

Question 15

Pulseless Electrical Activity (PEA)

Answer 15

-Treat etiologies (PE, acidosis, hypoxia, hypoK, OD, trauma)

Good CPR +
-Epi 1 mg Q5 min with Vasopressin 40 u IVP

Question 16

Asystole

Answer 16

Lack of electrical activity

TX: CPR +
-Epi 1 mg Q5 min with Vasopressin 40 u IVP