Cardiac Powerpoint Review Flashcards
Narrorw QRS regular tachycardia is known as
SVT
*if P waves can be seen then its regular tachycardia
If adequate rate control of Afib can not be achieved via medications (BB, CCB, amio or digoxin) it may be necessary to
cardiovert.
SVT treatment
Adenosine 6mg, 12mg
There is a high risk for _______ in patients with Afib.
Stroke
Afib symptoms
- lightheaded, dizziness, fatigue
- CP, dyspnea
- LE swelling
Afib treatment
- Warfarin
-DOACs (Dbigatran, Rivaroxaban, Apixaban, Edoxaban) - Triple therapy if increased risk for stroke (oral anticoagulant, clopidogrel, ASA)
Paroxysmal afib
- self terminating within 48 hrs
persistent AFib
- Lasts longer than 7 days
- including those terminated by cardioversion
Why we synchronize in direct current cardioversions…
Avoid the post-shock complication of VFib or VT!
CHB stable sequence
Transcutaneous pads- evaluate for reversibility
non reversible- needs Pace maker
reversible- treat cause
Unstable CHB sequence
atropine- transcutaneous pads-
if Low BP–> IV Dopamine
if HF—> IV Dobutamine
normal BP, no HF–> transvenous pacing
when stabilized assess for reversible causes—- none or CHB persists (PPM)
In CHB : TREAT _________CAUSES
UNDERLYING
Support symptomatic bradycardias/ heart blocks with ________until permanent pacemaker (PPM) is indicated
temporary pacing
Indication for permanent pacemaker
SYMPTOMATIC bradycardias and heart blocks that are NOT reversible or time-limited
Others: Sick sinus syndrome, tachy-brady syndrome, chronic Afib with slow ventricular response, hypersensitive carotid sinus syndrome
Symptoms are: dizziness, syncope, near-syncope, hypotension, lightheadedness, decrease in exercise tolerance
in Monomorphic VT all ____ look alike
QRS COMPLEXES
Monomorphic VT treatment
Pulseless: Defibrillate
symptomatic: sedate and cardiovert
Antiarrythmic drugs:
- AMio bolus mg IV or 300 mg (IF PULSELESS)
- Lidocaine
- procainamide up to 17 mg/kg at 20 mg/min
Indication for ICD would be
recurrent VT
- (Primary) Low EF due to ischemic heart disease ( < 35, <30)
- (secondary) sudden cardiac arrest due to VT or VF, unexplained syncope, stable/unstable VT
Long term treatment for VT would include
BB, sotalol, amiodarone
normal QTc is
< 0.46 sec in me
< 0.47 in women
Torsades most common in QTc of
0.50 sec or more
Polymorphic VT with normal QT occurs with
acute Ischemia
typically not drug induced.
Polymorphic VT with normal QT meds
Treat ischemia– revascularization if indicated
Beta blockers
Lidocaine can be considered especially if ischemic
Amiodarone– pulm fibrosis, transaminitis, pneumotoxicity
Defibrillate, if sustained and pulseless
Acquired Torsades caused by
Antiarrhythmics, antibiotics, antidepressants, anti-acid, antihistamines, Haldol
Electrolyte imbalances– hypokalemia, hypomagnesium
Severe bradycardias
Acquired torsades treatment
discontinue causing agent, correct electrolytes, give Mg and defibrillate
Immediate ED general treatment for ACS
- O2 if less than 94%
- ASA 160- 325 mg (if not given by EMS)
- nitroglycerin SL or spray
- Morphine IV if discomfort not relieved by nitro
STEMI treatment
Reperfusion
PCI
Fibrinolysis
UA/NSTEMI treatment
- Heparin
- Nitro
- PO BB
- consider Plavix
ACE/ARB
statin therapy
Fibrinolitic checklist
- CP >15 min and less than 12 hrs
- Does EKG show STEMI OR new LBBB
Most sensitive and specific marker for myocardial damage is
Troponin I
contraindications for fibrinolysis
- recent surgery (2-4 wks)
- bleeding or clotting problem
- pregnant female
- head/facial trauma
- any hx of ICH
Inferior wall MIs can cause
heart blocks
_________ MIs have higher mortality than Inferior wall MIs
Anterior wall
Lateral wall leads
I, aVL, V5, V6
Inferior wall leads
II, III, aVF
Septal wall leads
V1, V2
Anterior wall leads
V3, V4
FDA has approved ______________for use in all patients with HFpEF, with benefit most likely in patients with less than normal LV systolic function.
sacubitril/valsartan
_____________reduced HF hospitalization in patients with HFpEF in a large randomized trial, but mortality was not reduced.
Spironolactone
Hypertensive emergency
SBP >180 or DP >120 AND end organ dysfunction
Aortic stenosis murmur sounds like
ahigh-pitched, harsh, crescendo-decrescendo systolic sound that’s loudest over the second right intercostal space and can radiate to the carotid arteries
Triad of symptoms for Aortic stenosis
- Syncope
- Angina
- Dyspnea
Mitral regurgitation murmur sounds like
a whooshing sound, or systolic murmur
Mitral regurgitation murmur is best heard at the
apex of the heart and radiates to the left axilla
- best heard on left side
Mitral stenosis cause
- common in pregnant women
- rheumatic fever
aortic stenosis causes
- calcification and degeneration of valve
treatment: valve replacement
