Cardiac Rhythm Disorders Treatments [according to Master the Boards]

Question 1

When is a “precordial thump” the answer?

Answer 1

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.

Question 2

Pulselessness management

Answer 2

CPR.

Question 3

Asystole

Answer 3

Besides CPR, therapy for asystole is with epinephrine, which constricts blood
vessels in tissues such as the skin.

Question 4

Ventricular Fibrillation

Answer 4

shock, drug,
shock, drug, shock, drug, and CPR
at all times in between the shocks

Question 5

After another attempt at defibrillation, the most appropriate next step in
management is_____________

Answer 5

epinephrine followed by another electrical shock

Question 6

Pulseless VT:

Answer 6

Manage in exactly the same way as VF.

Question 7

Hemodynamically unstable VT

Answer 7

Perform electrical cardioversion several
times, followed by medications such as -Amiodarone, lidocaine, or
procainamide.

Question 8

Hemodynamically stable VT:

Answer 8

Treat with medications such as Amiodarone,
then lidocaine, then procainamide. If all medical therapy fails, then
cardiovert the patient.

Question 9

Pulseless Electrical Activity

Answer 9

correct the underlying cause,
Tamponade
Tension pneumothorax
Massive pulmonary embolus (PE)
Potassium disorders, either high or low

Question 10

Hemodynamically unstable atrial arrhythmias are managed with____

Answer 10

synchronized

cardioversion. no previous anticoagulation required

Question 11

Chronic Atrial Fibrillation treatment fundament

Answer 11

Rate control and anticoagulation are the standard of care for atrial
fibrillation.

Question 12

Chronic Atrial Fibrillation treatment drugs

Answer 12

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.)

Question 13

“Lone” Atrial Fibrillation: CHADS Score ≤1 Treatment

Answer 13

aspirin alone

Question 14

CHADS VASc Score

Answer 14

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

Question 15

___________reverses rivaroxaban, apixaban, and edoxaban.

Answer 15

Andexanet

Question 16

__________reverses dabigatran.

Answer 16

Idarucizumab

Question 17

____________reverses warfarin.

Answer 17

Prothrombin complex concentrate (PCC)

Question 18

Supraventricular Tachycardia ttm

Answer 18

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

Question 19

Supraventricular tachycardia (SVT) EKG findings

Answer 19

narrow complex

tachycardia without P waves, fibrillatory waves, or flutter waves.

Question 20

Supraventricular Tachycardia cure

Answer 20

radiofrequency catheter ablation

Question 21

Wolff-Parkinson-White Syndrome Acute therapy:

Answer 21

Procainamide or amiodarone- Use them only if WPW is currently presenting
with an arrhythmia.

Question 22

Wolff-Parkinson-White Syndrome

Answer 22

Chronic therapy: Radiofrequency catheter ablation

Question 23

Multifocal Atrial Tachycardia ttm

Answer 23

Treat the underlying lung disease
and
Treat MAT as you would
atrial fibrillation, but avoid beta blockers

Question 24

Multifocal Atrial Tachycardia EKG findings

Answer 24

MAT has at least 3 different P-wave morphologies and is

associated with COPD

Question 25

Sinus Bradycardia

Answer 25

Atropine “best initial
therapy” and pacemaker “the most effective therapy.”are used
for sinus bradycardia only if
symptomatic.

Question 26

First-Degree AV block

Answer 26

Use the same management as sinus bradycardia.

Question 27

Second-Degree AV block - Mobitz I or Wenckebach Block

Answer 27

If

there are no symptoms, it is managed in the same way as sinus bradycardia. Do not treat if asymptomatic.

Question 28

Mobitz II Block

Answer 28

pacemaker

Question 29

Third-Degree or Complete Heart Block.

Answer 29

pacemaker

Question 30

Torsades de pointes

Answer 30

Mg (stable) and Shock (unstable)

Question 31

AFib Tx in a pt w CHF

Answer 31

Avoid BB and CCB

Use digoxine or amiodarone