Arrythmias

Question 1

Tx of acute, stable afib?

Tx of acute, unstable afib?

Tx of chronic afib?

Answer 1

acute, stable = anticoagulate + rate control w/ Ca-blockers, then cardioversion

acute, unstable = immediate cardioversion

Chronic = anticoagulate + rate control w/ Ca-blockers

Question 2

Management of WPW?

EKG finding?

Answer 2

ablation

delta wave

Question 3

Tx of sustained VTach?
Tx of nonsustained VTach?
Tx of torsades?

Answer 3

sustained (> 30s) = IV amiodarone

nonsustained (<30s)= reassurance

torsades (rapid, polymorphic Vtach due to QT prolongation) = IV Mg sulfate

Question 4

Tx of sinus brady (if sx)?

Answer 4

atropine (blocks vagus)

Question 5

Sick sinus syndrome sigs and smx?

tx?

Answer 5

persistent sinus bradycardia; presents as dizziness, syncope, fatigue 

tx = pacemaker

Question 6

Disease location of:
2° AV block (Mobitz type 1)?
2° AV block (Mobitz type 2)?

Answer 6

1 = AV node

2 = bundle of HIS

Question 7

Tx of:
2° AV block (Mobitz type 1)?
2° AV block (Mobitz type 2)?

Answer 7

1 = reassurance

2 = pacemaker (can convert to 3° w/o Tx)

Question 8

What do you expect to see on EKG for pt with premature atrial contraction?

Sx? Tx?

Answer 8

early P wave that looks diff than other p waves

*due to premature heartbeats arising in the atria that trigger depolarization before the SA node

ususally asmx, but can be persived as skipped beat

reassurance

Question 9

What do you expect to see on EKG for pt with PVC?

Answer 9

wide QRS without P wave

Couplet: 2 PVCs
Bigeminy: sinus beat + PVC
Trigeminy: sinus beat + 2 PVCs

Question 10

sawtooth with baseline HR of 150

Answer 10

AFlutter

Question 11

treatment of A flutter?

Answer 11

same as Afib:

acute, stable = anticoagulate + rate control w/ Ca-blockers, then cardioversion

acute, unstable = immediate cardioversion

Chronic = anticoagulate + rate control w/ Ca-blockers

Question 12

looks like AFib but P waves are variable, need 3 diff P waves for dx

Answer 12

MAT (multifocal atrial tachycardia), type of SVT

Question 13

cause of MAT

Answer 13

lung dz/hypoxia, MCC = COPD exacerbation or end stage COPD

also occurs after MI, hypoK and hypoMg

Question 14

Vfib tx?

Answer 14

immediate defib + CPR then continue IV amiodarone

Question 15

EKG shows activity but no pulses felt

Answer 15

pulseless electrical activity which is a type of vfib

Question 16

what does 1° AV block look like on EKG? Tx?

Answer 16

PR interval >0.2s

reassurance

Question 17

progressive PR prolongation until QRS drops, dz in AV node

Answer 17

2° AV block (Mobitz type 1)

Question 18

random QRS drop, dz in bundle of His

Answer 18

2° AV block (Mobitz type 2)

Question 19

P waves and QRS complexes function independently

Answer 19

3° AV block (complete)

Question 20

how to determine axis? and right vs left deviation

Answer 20

look at leads I and II
• I+/II+: normal
• I+/II–: left-axis deviation
• I–/II+: right-axis deviation

Question 21

normal PR interval

Answer 21

< 0.2 s (heart block if > 0.2)

Question 22

normal QRS

Answer 22

<0.12 sec

Question 23

what does LBBB look like

Answer 23

WiLLiaM – W shape in V1-V2, M in V3-V6

Question 24

what does RBBB look like

Answer 24

MaRRoW – M in V1-V2, W in V3-V6

Question 25

lead II wide P-wave (>0.12 sec)

Answer 25

left atrium enlargement

Question 26

lead II tall P-wave (>2.5 mm)

Answer 26

right atrium enlargement

Question 27

left-axis deviation + V1/V2 and V5/V6 overlapping

Answer 27

LVH

Question 28

right-axis deviation + lead V1 R-wave >7 mm

Answer 28

RVH

Question 29

T-wave inversion, ST elevation or depression

Answer 29

ischemia

Question 30

: T-wave inversion, ST elevation, significant Q waves

Answer 30

infarction