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S20 Clin-Med > cardio 3 > Flashcards

cardio 3 Flashcards

1
Q

causes of dysrhytmias

A

ischemia, SNS stimulation, electrolyte imbalances, drugs

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2
Q

sick sinus syndrome

A

aka tachy-brady syndrome; usually brady episodes are what prompt patient to seek help

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3
Q

treatment of sick sinus treatment

A

if asymptomatic leave it alone; symptomatic needs pacemaker

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4
Q

causes of AV block

A

damage to the AV node or medications (BB, CCB, digoxin)

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5
Q

findings in first degree heart block

A

PR prolongation

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6
Q

treatment of first degree av block

A

no need if asymptomatic; catacholamine responsive

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7
Q

cause of mobitz 1

A

inferior MI with AV node ischmia (AVN artery is a branch of RCA)

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8
Q

findings in mobitz 1 winchebach

A

gradual prolongation of PR interval then drop; QRS usually normal

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9
Q

treatment for mobitz 1 winchebach

A

catecholamine responsive; no need for pacing if no bradycardia

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10
Q

cause of mobitz 2

A

diseased bundle of HIS

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11
Q

findings in mobitz 2

A

PR interval constant w dropped QRS; QRS likely to be wide if below bundle of HIS

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12
Q

treatment of mobitz 2

A

not catecholamine responsive because below the AV node= worsens number of dropped beats

prophylactic pacemaker

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13
Q

mobitz 2 may be a precursor for what

A

complete heart block

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14
Q

findings in 3rd degree heart block

A

atria beat faster than they did before the block occured as a CNS response to low CO
AV and VA block

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15
Q

treatment of 3rd degree heart block

A

pacemaker

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16
Q

major causes of LBBB

A

cardiomyopathy, CAD, extensive conduction system disease

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17
Q

how is the septum normally activated?

A

from left to right

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18
Q

how is the septum activated with a LBBB

A

right to left; impulse goes to the RV first then to the LV via septum

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19
Q

how does a LBBB affect the QRS

A

extended duration and eliminates normal septal q waves in lateral leads

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20
Q

EKG findings in LBBB

A

tall r waves and loss of s and q waves in the lateral leads; deep s waves in the right precordial leads’ LAD

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21
Q

ekg findings in RBBB

A

bunny ears in lateral leads; axis is unchanged because depolarization is normal

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22
Q

most common bifasicular block

A

RBBB plus LAFB

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23
Q

which bifasicular block causes RAD

A

LPFB

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24
Q

which bifasicular block causes LAD

A

LAFB

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25
Q

cause of bifasicular block

A

ischemic heart disease

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26
Q

treatment for bifasicular block

A

pacemaker if syncope occurs

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27
Q

indications for a pace maker

A

symptomatic brady
asymp HR<40
persistent/symptomatic mobitz/3rd deg

overdrive pacing for tachy

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28
Q

factors that enhance automaticity

A

SNS stim, high co2, high pH, high stretch, high calcium, low PNS, low o2, low potassium, sympathomimetics

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29
Q

parasystole

A

automaticity that affects only an isolated small region of atrial or ventricular cells

30
Q

what operates SA and AV node

A

slow calcium channels that are quick to recover

31
Q

what is bachmans bundle

A

crosses to activate left atrium

32
Q

what operates atria, bundle of HIS and perkinge finbers

A

fast sodium channels that are slow to recover

33
Q

findings in MAT

A

more than 3 types of P waves

34
Q

causes of SVT

A

increased automaticity and re-entry

35
Q

who is more likely to get PSVT

A

young women

36
Q

acute treatment of WPW

A

no use of agents that further slow AV node because accessory pathway will be more prominent; amioderone/CV

37
Q

general treatment for SVT (not AVRT)

A

vagal maneuvers, adenosine/verap/BB; ablation

38
Q

what is the most common dysrythmia

A

a fib

39
Q

mechanism of afib

A

multiple reentry wavelets involving one or more circuits

40
Q

where is the usual source of rentry signals in afib

A

around entry of pulmonary veins into the LA

41
Q

what does a fib put patient at risk of

A

blood clot

42
Q

paroxysmal afib

A

episodes last less than a week but usually less then 24 hours; prevent triggers

43
Q

persistant a fib

A

more than 7 days; cardioversion; restore NSR and prevent triggers

44
Q

permanent Afib

A

more than a year; no cardioversion; control rate and anticoagulation

45
Q

lone a.fib

A

any of the other types in a young person with no structural heart disease

46
Q

what is the rate goal

A

less than 100

47
Q

indications for rhythm control

A

persistent symptoms despite adequate rate control, inability to attain adequate rate control, patient preference, contraindication or patient preference to avoid anticoagulation

48
Q

when do you do CV immediatly

A

urgent symptomatic cases- chest pain, MI, cardio collapse

49
Q

what can you CV afib without anticoagulation

A

duration less than 48 hours or if absence of thrombus is assured by trans esophageal ultrasound

50
Q

what do you do if a thrombus is present of if history is uncertain in the absence of ultrasound capabilities?

A

anti coagulate with warfarin for 3 weeks before and 4 weeks after

51
Q

CHADS2

A 
CHF
HTN
Age greater than 75
DM
Stroke or tia
52
Q

CHA2DS2-VASc

A 
CHF
HTN
Age greater than 75
DM
stroke or TIA
vascular disease
age 65-74
sex (female)
53
Q

who is more at risk of having a stroke with a fib

A

women

54
Q

chad score 0

A

no anticoag; aspirin

55
Q

chad score 1

A

can be untreated or put on oral anticoag..if female give anticoag

56
Q

chads score more than 2

A

oral anticoagulation

57
Q

who gets anticoag regardless of chads scrore

A

people with prosthetic valves, or valvular conditions

58
Q

watchman device

A

reduces the risk of left atrial appendage blood clot embolization

59
Q

what should patients take after watchman device implanted

A

2-3 months of aspirin

60
Q

what increases risk of vtach

A

hypokalemia and hypomagnesemia

61
Q

what is nonsustained VT

A

3 or more ventricular beats in a roq but lasts less than 30 sec

62
Q

when should nonsustains vt be treated?

A

if associated with hypertophic cardiomyopathy; not for valvular or dilated

63
Q

cause of tosades

A

drugs that increase Qt interval, hypokalemia, hypomagnesemia, hypocalcemia, bradycardia

64
Q

what is the most common dyshythmia resulting in out of hospital cardiac arrest

A

vfib

65
Q

tx for vfib

A

defibrillation and amioderone

66
Q

what class are BB

A

2

67
Q

what class is amioderone

A

III, Ib

68
Q

what is amioderoe useful for treating

A

SVT, VT, afib/flutter

69
Q

what do you have to monitor for when using amioderone

A

hepatotoxicity, pulm fibrosos, hypothyroidism, pro-arrythmic effects

70
Q

indications for magnesium sulfate

A

torsades, dysthymia in patient with hypomagnesemia, digoxin induced dysrhythmias, acute ischemia to prevent ventricular dysrthymias

S20 Clin-Med (10 decks)

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