Cardiac Powerpoint Review

Question 1

Narrorw QRS regular tachycardia is known as

Answer 1

SVT

*if P waves can be seen then its regular tachycardia

Question 2

If adequate rate control of Afib can not be achieved via medications (BB, CCB, amio or digoxin) it may be necessary to

Answer 2

cardiovert.

Question 3

SVT treatment

Answer 3

Adenosine 6mg, 12mg

Question 4

There is a high risk for _______ in patients with Afib.

Answer 4

Stroke

Question 5

Afib symptoms

Answer 5

• lightheaded, dizziness, fatigue
• CP, dyspnea
• LE swelling

Question 6

Afib treatment

Answer 6

• Warfarin
  -DOACs (Dbigatran, Rivaroxaban, Apixaban, Edoxaban)
• Triple therapy if increased risk for stroke (oral anticoagulant, clopidogrel, ASA)

Question 7

Paroxysmal afib

Answer 7

• self terminating within 48 hrs

Question 8

persistent AFib

Answer 8

• Lasts longer than 7 days
• including those terminated by cardioversion

Question 9

Why we synchronize in direct current cardioversions…

Answer 9

Avoid the post-shock complication of VFib or VT!

Question 10

CHB stable sequence

Answer 10

Transcutaneous pads- evaluate for reversibility

non reversible- needs Pace maker

reversible- treat cause

Question 11

Unstable CHB sequence

Answer 11

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)

Question 12

In CHB : TREAT _________CAUSES

Answer 12

UNDERLYING

Question 13

Support symptomatic bradycardias/ heart blocks with ________until permanent pacemaker (PPM) is indicated

Answer 13

temporary pacing

Question 14

Indication for permanent pacemaker

Answer 14

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

Question 15

in Monomorphic VT all ____ look alike

Answer 15

QRS COMPLEXES

Question 16

Monomorphic VT treatment

Answer 16

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

Question 17

Indication for ICD would be

Answer 17

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

Question 18

Long term treatment for VT would include

Answer 18

BB, sotalol, amiodarone

Question 19

normal QTc is

Answer 19

< 0.46 sec in me
< 0.47 in women

Question 20

Torsades most common in QTc of

Answer 20

0.50 sec or more

Question 21

Polymorphic VT with normal QT occurs with

Answer 21

acute Ischemia

typically not drug induced.

Question 22

Polymorphic VT with normal QT meds

Answer 22

Treat ischemia– revascularization if indicated

Beta blockers

Lidocaine can be considered especially if ischemic

Amiodarone– pulm fibrosis, transaminitis, pneumotoxicity

Defibrillate, if sustained and pulseless

Question 23

Acquired Torsades caused by

Answer 23

Antiarrhythmics, antibiotics, antidepressants, anti-acid, antihistamines, Haldol

Electrolyte imbalances– hypokalemia, hypomagnesium

Severe bradycardias

Question 24

Acquired torsades treatment

Answer 24

discontinue causing agent, correct electrolytes, give Mg and defibrillate

Question 25

Immediate ED general treatment for ACS

Answer 25

• 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

Question 26

STEMI treatment

Answer 26

Reperfusion

PCI
Fibrinolysis

Question 27

UA/NSTEMI treatment

Answer 27

• Heparin
• Nitro
• PO BB
• consider Plavix

ACE/ARB
statin therapy

Question 28

Fibrinolitic checklist

Answer 28

• CP >15 min and less than 12 hrs
• Does EKG show STEMI OR new LBBB

Question 29

Most sensitive and specific marker for myocardial damage is

Answer 29

Troponin I


Question 30

contraindications for fibrinolysis

Answer 30

• recent surgery (2-4 wks)
• bleeding or clotting problem
• pregnant female
• head/facial trauma
• any hx of ICH

Question 31

Inferior wall MIs can cause

Answer 31

heart blocks

Question 32

_________ MIs have higher mortality than Inferior wall MIs

Answer 32

Anterior wall

Question 33

Lateral wall leads

Answer 33

I, aVL, V5, V6

Question 34

Inferior wall leads

Answer 34

II, III, aVF

Question 35

Septal wall leads

Answer 35

V1, V2

Question 36

Anterior wall leads

Answer 36

V3, V4

Question 37

FDA has approved ______________for use in all patients with HFpEF, with benefit most likely in patients with less than normal LV systolic function.

Answer 37

sacubitril/valsartan

Question 38

_____________reduced HF hospitalization in patients with HFpEF in a large randomized trial, but mortality was not reduced.

Answer 38

Spironolactone

Question 39

Hypertensive emergency

Answer 39

SBP >180 or DP >120 AND end organ dysfunction

Question 40

Aortic stenosis murmur sounds like

Answer 40

ahigh-pitched, harsh, crescendo-decrescendo systolic sound that’s loudest over the second right intercostal space and can radiate to the carotid arteries

Question 41

Triad of symptoms for Aortic stenosis

Answer 41

• Syncope
• Angina
• Dyspnea

Question 42

Mitral regurgitation murmur sounds like

Answer 42

a whooshing sound, or systolic murmur

Question 43

Mitral regurgitation murmur is best heard at the

Answer 43

apex of the heart and radiates to the left axilla

• best heard on left side

Question 44

Mitral stenosis cause

Answer 44

• common in pregnant women
• rheumatic fever

Question 45

aortic stenosis causes

Answer 45

• calcification and degeneration of valve

treatment: valve replacement