Arythmie et FA Flashcards

Question

Overdrive Flutter

Answer 1

Pacing A 5-10% plus rapide que flutter. Retenter en réduisant CL 5-10 msec

Answer 2

P + en V1: vient de l'OG (- en aVL) P - en Va: vient de l'OD (+ ou biphasique en aVL)

Answer 3

BCC ou BB seul Fléca ou propafénone + BCC/BB Sotalol Amio Overdrive

Answer 4

FR: MPOC, HTP, MCAS/valves, hypoMg, théophylline Tx: BCC ou amio, Mg+

Answer 5

6 mg IV en 1-2 secondes 12 mg IV après 1-2 min répétable x1

Answer 6

BB - BCC - Ic - III

Answer 7

Voie lente: inf-post au NAV (entre anneau septal IC et ostium sinus coronaire)

Answer 8

Période réfractaire < 240 msec

Answer 9

RR <250 msec en FA pré-excitée Faisceaux accessoires multiples AVRT inductible AVRT précipitant FA pré-excitée Période réfractaire du faisceau 240 msec

Answer 10

Permanent form of junctional reciprocating tachycardia: -AVRT ortho incessante sur faisceau postero-septal D>G avec conduction rétrograde lente P - en II-III-aVF

Answer 11

AVRT QRS large morpho BBG, transition précordiale tardive

Answer 12

0 - 1.9% 1 - 2.8% 2 - 4.0% 3 - 5.9% 4 - 8.5% 5 - 12.5% 6 - 18.2%

Answer 13

Non-modifiables: âge et sex Modifiables: HTA, AOS, obésité Induit par FA: remodelage électrique et structurel

Answer 14

Advancing age Male sex Hypertension HF with reduced ejection fraction Valvular heart disease Overt thyroid disease Obstructive sleep apnea Obesity Excessive alcohol intake Congenital heart disease (eg, early repair of atrial septal defect)

Answer 15

Prehypertension and increased pulse pressure Chronic obstructive pulmonary disease HF with preserved ejection fraction Subclinical hyperthyroidism Coronary artery disease Morphometric (increased height, increased birth weight)

Answer 16

Familial/genetic factors Tobacco use Left atrial dilatation LV hypertrophy Inflammation Diabetes Pericardial fat Subclinical atherosclerosis Chronic kidney disease Excessive endurance exercise Electrocardiographic (atrial conduction delay, PR interval prolongation)

Answer 17

Ibrutinib (anti-TK)

Answer 18

Stimulants ROH Sleep deprivation Emotional stress Exertion Sleep Digestive

Answer 19

Severity of Atrial Fibrillation 0: Asx 1: minimal effect on QOL (single episode or minimal/no Sx) 2: minor effect (rare episodes with mild awareness of Sx) 3: moderate impact; more than every few months 4: unpleasant Sx; frequent; HF or syncope

Answer 20

-Tabac et ROH <1 die (abstinence in some patients) -Exercise: 30 min moderate 3-5 times per week (>200 min). 2-3 times resistance training. -BP <130/80 (<200/100 at peak exercise): IECA/ARA might be preferred -OSA: CPAP is AHI>15/h -Db <7.0% -Poids: perte >10% et BMI <27

Answer 21

Age ≥80 years, ≥75 years with other bleeding risk factors including CrCl 30-50mL/min (

Answer 22

2 of the 3: 1) age ≥80 years, 2) body weight ≤60 kg, or 3) serum creatinine ≥133 mol/L

Answer 23

CrCl 30-49 ml/min <60 kg Utilisation inhibiteur glycoprotéine P (verapamil, quinidine, dronédarone)

Answer 24

20 mg po die CrCl >50 ml/min 15 mg po die CrCl 30-49 ml/min

Answer 25

>60 ml/min: q12 months 30-60 ml/min: q6 months 15-30 ml/min: q3 months (stage 4)

Answer 26

-Apixaban 5 mg po BID -Xarelto 15 mg po die (10 mg po die si IRC) -Edoxaban 60 mg po die (30 mg po die si <60 kg, CrCl <50 ml/min) -Dabigatran 110 ou 150 mg po BID -Coumadin INR 2.0-2.5

Answer 27

Apixaban 5 mg po BID Xarelto 2.5 mg po BID Coumadin INR 2.0-2.5

Answer 28

CI si: -Child-Pugh C -Cirrhose avec coagulopathie significative Si IH sévère et INR <1.7, considérer coumadin

Answer 29

DOAC in simple or moderate CHD w/o recent cardiac surgery <3 months, mechanical valve, AV valve stenosis with enlarged and diseased atria

Answer 30

Severe CHD (cyanotic or single ventricle physiology): WARFARINE

Answer 31

Any surgery or procedure with neuraxial (spinal or epidural) anaesthesia Neurosurgery (intracranial or spinal) Cardiac surgery (eg, CABG, heart valve replacement) Major vascular surgery (eg, aortic aneurysm repair, aortofemoral bypass) Major orthopaedic surgery (eg, hip/knee joint replacement surgery) Lung resection surgery Urological surgery (eg, prostatectomy, bladder tumour resection) Extensive cancer surgery (eg, pancreas, liver) Intestinal anastomosis surgery Reconstructive plastic surgery Selected procedures involving vascular organs (eg, kidney biopsy, prostate biopsy) Selected high bleed risk interventions (eg, colonic polypectomy, spinal injection, pericardiocentesis)

Answer 32

Abdominal surgery (eg, cholecystectomy, hernia repair, colon resection) Other general surgery (eg, breast) Other intrathoracic surgery Other orthopaedic surgery Other vascular surgery Non-cataract ophthalmologic surgery Gastroscopy or colonoscopy with biopsies Coronary angiography* Selected procedures with large-bore needles (eg, bone marrow biopsy, lymph node biopsy) Complex dental procedure (eg, multiple tooth extractions)

Answer 33

ASA, >60 years old and one risk factor of bleeding

Answer 34

TIA: 24h NIHSS <8: >/=3j NIHSS 8-15: >/= 6j NIHSS >16: >/= 12j Other factors: moderate ischemic stroke on CT, hemorragic transformation, advanced age, uncontrolled BP, coagulopathy

Answer 35

LAA thrombus/stasis Ventricle thrombus Mechanical valve Hypercoagulability

Answer 36

Moderate to high risk stroke with CI to Aco: -recurrent nontraumatic -intracranial bleeding with high risk of recurrence, -recurrent irreversible pulmonary bleed, -recurrent irreversible urogenital bleed, -recurrent irreversible GI bleed, -recurrent irreversible retroperitoneal bleed, -esophageal varices, -intraocular bleeds, -hereditary hemorrhagic telangiectasia.

Answer 37

Recent dx <1 an Induced CMP Difficulty achieving good rate control Highly symptomatic or effect on QOL Multiple recurrence

Answer 38

FR: female, low weight, CKD Target with EF <40%: 0.5 à 0.9 ng/mL

Answer 39

Prolonged QTc (>440 ms), History of HF (typically defined as clinically symptomatic NYHA classification > II), Reduced EF, Signs of an ACS, Low serum potassium or magnesium levels. ES: TdeP et TV(NS)

Answer 40

-Induced CMP -CRT -HF -Mitral stenosis -Angina

Answer 41

Amiodarone Sotalol Dronedarone

Answer 42

IV procaïnamide IV ibutilide

Answer 43

-Warfarin + ASA x45j puis ASA-plavix ad 6 mois puis ASA seule -ASA-Plavix 1-6 mois puis ASA seule Si chirurgicale: poursuivre Aco***

Answer 44

Hypertension >160 Abnormal LFT ou renal function (créat >200) Stroke Bleeding disorders Labile INR Elderly > 65 Drugs or ROH (>8/j) 3 pts = 3.74% risque annuel sgt majeur

Answer 45

Permanent Form of Junctional Reciprocating Tachycardia AVRT orthodromique incessante. Faisceau avec conduction unidirectionnelle rétrograde lente. Postéro-septale D>G. R-P long. P négative en II, III, aVF.

Answer 46

FA valvulaire [sténose mitrale modérée à sévère (rhumatismale ou non) et valve mécanique] Congénital modéré à sévère (Fontan, cyanogène) Échec au DOAC Cirrhose Child-Pugh C

Answer 47

Léger à modéré: NACO > VKA en absence de chx cardiaque récente (<3 mois), valve mécanique, sténose valve AV avec oreillettes dilatée et malade

Answer 48

Dabigatran: RELY (110 mg non inf. AVC; dim. sgt) Rivaroxaban: ROCKET-AF (non-infx, sgt idem) Apixaban: ARISTOTLE (sup. pour AVC; seul avec dim. mortalité totale) Edoxaban: ENGAGED-AF (30 mg tendance aug. AVC, dim. sgt, dim. mortalité totale)

Answer 49

Temps ad conversion moyen: 2-6 heures Temps monitoring requis: 6h post administration pour la 1re dose Effets secondaires; hypoTA, bradycardique, FLA conduction 1:1, arythmie ventriculaire À éviter si : MCAS, insuffisance cardiaque, hypoTA et Brugada

Answer 50

Timolol Propranolol Pindolol Métoprolol Esmolol Labétalol Carvédilol

Answer 51

Aténolol Métoprolol Bisoprolol Esmolol Acébutolol

Answer 52

Tachycardia-related LBBB is believed to be caused by a defect in phase 3 (ie, repolarization) conduction at faster rates, whereby impulses are delayed or blocked entirely when they fall in the refractory period of the action potential.

Answer 53

-Increased vagal tone: sinus bradycardia, first degree atrioventricular block, rythme jonctionnel -Increased chamber size: LVH, HOG, HOD -Early repolarization pattern

Answer 54

Procaïnamide IV

Answer 55

Non compensatoire (redémarre le NS)

Answer 56

Flutter TAP

Answer 57

TS TAP FA/FLA Tachycardie jonctionnelle non paroxystique*

Answer 58

Automaticité augmentée NS Hypersensibilité béta Activité parasympathique diminuée

Answer 59

Sotalol Amio Dofétilide

Answer 60

VD latéral G antérograde seul* avec conduction décrémentielle

Answer 61

Paroxystique <7j Persistente >7j Persistente longue durée >12 mois Permanente: décision pas de convertir FA valvulaire: valve mécanique ou SM >/= modérée

Answer 62

CASTLE-AF AATAC-AF Dim. mortalité et H vs AAA PABA-CHF: supérieur vs CRT et ablation NAV

Answer 63

60-75% 1e fois 75-90% 2e fois

Answer 64

Thrombus OG

Answer 65

5-7% total Vasculaire: 1-2% Perforation/tamponnade: 1-2% TE: 1% Sténose VP: <0.5% FLA Fistule atrio-oesophagienne

Answer 66

Triade infx + DRS +AVC/AIT. Dx: CT Thoracique C+. Éviter gastroscopie

Answer 67

Garder coumadin et NACO périprocédure, puis min 2 mois, puis selon CHADS

Answer 68

-4F-PCC (concentré de complexe prothrombinique): 25-50 U/kg Beriplex, etc. -Vitamine K 10 mg (max 1mg/min) -Plasma frais congelé: 8 unités si PCC non dispo

Answer 69

Apix 25% Xarelto 33% Edox 50% Dabi 80%

Answer 70

-Idarucizumab pour dabigatran -Andexanet alfa pour anti-Xa (dose selon dernière dose de Naco) -4F-PCC: 50 U/kg IV si antidote non disponible

Answer 71

PROTECT-AF et PREVAIL avec Watchman

Answer 72

DAPT 6 mois puis ASA seule

Answer 73

Ibutilide Procaïnamide CVE

Answer 74

>/= 6 min sur device. Aco si >=24h

Answer 75

HF Exercice Arterial HTN Db Tabacco Obesity* Ethanol Sleep apnea

Answer 76

<100 bpm Strict: -HF -CMP-tachyarythmique -Sx -Risk of ICD inappropriate shock -CRT to optimize pacing