Cardiac Arrhythmias

Question 1

Irregularly Irregular Rhythym

Narrow QRS waves

No P wave

Answer 1

A-fib

Question 2

4 Types of A-fib

Answer 2

Paroxysmal: self-terminating within 7 days

Persistent: lasts > 7 days

Permanent: AF > 1 yr

Lone: Any of the above w/o evidence of heart disease

Question 3

Rate Control for A-Fib

Answer 3

BB: Metoprolol

CCB: Diltiazem

Digoxin: old people w/ hypotension or CHF

Question 4

What kind of A-fib patient population do you want to use Digoxin for?

Answer 4

old people w/ hypotenstion or CHF

Question 5

Tx for Unstable A-fib

Answer 5

Synchronized cardioversion

Question 6

No P waves

regular rate

unstable atria

Answer 6

atrial flutter

Question 7

Tx for stable atrial flutter

Answer 7

1st = vagal manuevers

BB, CCB

Question 8

Tx for unstable A-flutter

Answer 8

synchronized cardioversion

Question 9

Definitive tx for a-flutter

Answer 9

radiofrequency ablation

Question 10

Anticoagulation risk stratification in nonvalvular a-fib

Answer 10

CHA2DS2-VASc Criteria

Question 11

CHA2DS2 Vasc

Answer 11

Congestive Heart Failure

Hypertension

Age ≥ 75y

Diabetes Mellitus

Stroke, TIA, Thrombus

Vascular disease (Prior MI, aortic plaque, peripheral arterial disease)

Age 65- 74

Sex (female)

Question 12

CHA2DS2 VASC Score ≥ 2 recommended therapy

Answer 12

Mod-high risk: chronic oral anticoagulation

Question 13

CHA2DS2 VASC Score = 1 recommended therapy

Answer 13

Low risk: anticoag may be recommended, depends on patient

Question 14

CHA2DS2 VASC Score = 0 recommended therapy

Answer 14

No anticoag needed

Question 15

1st line tx for A-fib

Answer 15

Dabigatran (NOAC) (no need to check INR, lower risk of bleeding than warfarin)

Question 16

Def tx for Long QT syndrome

Answer 16

AICD

Question 17

2 pathways both within AV node

Answer 17

AV Nodal Reentry Tachy (AVNRT)

Question 18

1 pathway within the AV node & a 2nd accessory pathway OUTSIDE AV node

Answer 18

AV reciprocating Tachycardia (AVRT)

Question 19

Orthodromic conduction pattern

Answer 19

1st: impulse goes down normal AV node
2nd: Returns via accessory pathway in circles

NARROW COMPLEX TACHY

Question 20

Antidromic Conduction Pattern

Answer 20

1st: impulse goes down accessory pathway
2nd: returns via normal pathway

WIDE COMPLEX TACHY

Question 21

Tx for Stable Narrow Complex Tach

Answer 21

1. Vagal Manuevers

1st line tx = Adenosine, CCB

Question 22

Tx for unstable Narrow Complex Tachy

Answer 22

synch cardioversion

Question 23

Tx for Wide complex Tachy

Answer 23

Amiodarone

Procainamide if WPW**

Question 24

Tx for unstable WIDE complex tachy

Answer 24

synch cardioversion

Question 25

Def tx for SVT

Answer 25

radiofrequency ablation: electrically destroys abnormal pathways)

Question 26

WPW tx during pregnancy

Answer 26

sotalol flecainide

Question 27

**multiple ectopic atrial foci** generate impulses that are conducted to the ventricles ## Footnote **HR \< 100 + ≥ 3 P wave morphologies**

Answer 27

Wandering Atrial Pacemaker (WAP)

Question 28

same was WAP except HR is \> 100

Answer 28

Multifocal Atrial Tachycardia (MAT)

Question 29

What condition is MAT associated with?

Answer 29

**COPD**

Question 30

Tx for MAT

Answer 30

Verapamil or BB

Question 31

What does ECG of WPW show?

Answer 31

Delta wave (**slurred QRS upstroke)** **wide QRS** **Short PR Interval**

Question 32

What meds do you want to avoid in WPW?

Answer 32

ABCD: Adenosine, BB, CCB, Digoxin

Question 33

**wide, bizzare QRS complexes**

Answer 33

**Ventricular Dysrhythmias**

Question 34

Premature Ventricular Complexes

Answer 34

**premature beat originating from ventricles** **wide, bizarre QRS** occuring earlier than expected **T wave opposite direction of QRS**

Question 35

V Tach

Answer 35

**≥ 3 consecutive PVCs** at a rate **\> 100bpm**

Question 36

What is a common predisposing condition to V tach?

Answer 36

Prolonged QT interval

Question 37

Stable, sustained VT Tx

Answer 37

Amiodarone

Question 38

Unstable VT w/ pulse Tx

Answer 38

Synchronized cardio

Question 39

VT w/ no pulse

Answer 39

Defibrillation + CPR (tx as V fib)

Question 40

V fib Tx

Answer 40

defib + CPR

Question 41

organized rhythm seen on monitor but pt has no palpable pulse

Answer 41

pulseless electrical activity

Question 42

Tx for pulseless electrical activity

Answer 42

CPR + epi + check for shockable rhythm q 2 min

Question 43

RBBB Pattern ST elevation V1-V3

Answer 43

Brugada Syndrome

Question 44

Inheritance pattern of Brugada Syndrome

Answer 44

aut Dominant

Question 45

**Young boy w/ syncope** dad died of **sudden cardiac death** _NOT_ Hypertrophic Cardiomyopathy

Answer 45

**Brugada Syndrome**

Question 46

Tx for Brugada Syndrome

Answer 46

**AICD**

Question 47

Alcohol is associated with what cardiac arrhythmia?

Answer 47

a-fib

Question 48

most likely underlying tachydysrhythmia associated with this **Sick Sinus Syndrome**

Answer 48

A-fib

Question 49

Sick Sinus Syndrome

Answer 49

* Caused by **SA node dysfunction** * Pt will have **palpitations and syncope**

Question 50

ECG for Sick Sinus Syndrome will show

Answer 50

Tachy-Brady Syndrome

Question 51

Definitive Tx for Sick Sinus Syndrome

Answer 51

PPM + rate control

Question 52

Patients with repeated ECGs showing a **QTc interval \> 480 ms** with a **syncopal episode** OR **\> 500 ms in the absence of symptoms**, are diagnosed with

Answer 52

**Long QT syndrome**

Question 53

**Prolonged QT interval** is associated with

Answer 53

polymorphic ventricular tachycardia **(Torsades de pointes)**

Question 54

MC complication of Brugada Syndrome

Answer 54

V-fib

Question 55

caused by a **reentrant conduction pathway**

Answer 55

PSVT

Question 56

PSVT Tx

Answer 56

1. **Vagal Maneuvers** 2. **Adenosine** (narrow QRS complex)