Cardiac Rhythm Disorders Treatments [according to Master the Boards] Flashcards
When is a “precordial thump” the answer?
Very recent onset of arrest (<10 minutes) with no defibrillator
available
You know it is recent because you saw it happen (“witnessed”).
In short, pretty much never.
Pulselessness management
CPR.
Asystole
Besides CPR, therapy for asystole is with epinephrine, which constricts blood
vessels in tissues such as the skin.
Ventricular Fibrillation
shock, drug,
shock, drug, shock, drug, and CPR
at all times in between the shocks
After another attempt at defibrillation, the most appropriate next step in
management is_____________
epinephrine followed by another electrical shock
Pulseless VT:
Manage in exactly the same way as VF.
Hemodynamically unstable VT
Perform electrical cardioversion several
times, followed by medications such as -Amiodarone, lidocaine, or
procainamide.
Hemodynamically stable VT:
Treat with medications such as Amiodarone,
then lidocaine, then procainamide. If all medical therapy fails, then
cardiovert the patient.
Pulseless Electrical Activity
correct the underlying cause, Tamponade Tension pneumothorax Massive pulmonary embolus (PE) Potassium disorders, either high or low
Hemodynamically unstable atrial arrhythmias are managed with____
synchronized
cardioversion. no previous anticoagulation required
Chronic Atrial Fibrillation treatment fundament
Rate control and anticoagulation are the standard of care for atrial
fibrillation.
Chronic Atrial Fibrillation treatment drugs
control the rate with
beta blockers, calcium channel blockers, or digoxin. Once the rate is under
100 per minute, the most appropriate next step is to give dabigatran,
rivaroxaban, edoxaban, or apixaban (NOAC). Warfarin is used with metal
valves or mitral stenosis.
Anticoagulate. (Aspirin for low risk.)
“Lone” Atrial Fibrillation: CHADS Score ≤1 Treatment
aspirin alone
CHADS VASc Score
C: CHF or cardiomyopathy = 1 point H: hypertension = 1 point A: age >75 = 2 points D: diabetes = 1 point S: stroke or TIA = 2 points V: vascular disease (coronary, carotid, cerebral, peripheral) = 1 point A: age 65–74 = 1 point Sc: sex category (female) = 1 point
___________reverses rivaroxaban, apixaban, and edoxaban.
Andexanet
__________reverses dabigatran.
Idarucizumab
____________reverses warfarin.
Prothrombin complex concentrate (PCC)
Supraventricular Tachycardia ttm
1 Vagal maneuvers (e.g., carotid massage, Valsalva, dive reflex, ice
immersion)
2 Adenosine if vagal maneuvers don’t work
3 Beta blockers (metoprolol), calcium channel blockers (diltiazem), or digoxin
if adenosine is not effective
Supraventricular tachycardia (SVT) EKG findings
narrow complex
tachycardia without P waves, fibrillatory waves, or flutter waves.
Supraventricular Tachycardia cure
radiofrequency catheter ablation
Wolff-Parkinson-White Syndrome Acute therapy:
Procainamide or amiodarone- Use them only if WPW is currently presenting
with an arrhythmia.
Wolff-Parkinson-White Syndrome
Chronic therapy: Radiofrequency catheter ablation
Multifocal Atrial Tachycardia ttm
Treat the underlying lung disease
and
Treat MAT as you would
atrial fibrillation, but avoid beta blockers
Multifocal Atrial Tachycardia EKG findings
MAT has at least 3 different P-wave morphologies and is
associated with COPD
Sinus Bradycardia
Atropine “best initial
therapy” and pacemaker “the most effective therapy.”are used
for sinus bradycardia only if
symptomatic.
First-Degree AV block
Use the same management as sinus bradycardia.
Second-Degree AV block - Mobitz I or Wenckebach Block
If
there are no symptoms, it is managed in the same way as sinus bradycardia. Do not treat if asymptomatic.
Mobitz II Block
pacemaker
Third-Degree or Complete Heart Block.
pacemaker
Torsades de pointes
Mg (stable) and Shock (unstable)
AFib Tx in a pt w CHF
Avoid BB and CCB
Use digoxine or amiodarone
