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Emergency Med > Cardio > Flashcards

Cardio Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What pathway does electrical activity travel in parts of the heart?

A

Endocardium to epicardium

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2
Q

What pathway does vascularization travel in parts of the heart?

A

Epicardium to endocardium

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3
Q

How does a pacemaker work?

A

Leads go in RV and left subclavian vein

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4
Q

At what HR do the ventricles receive no benefit?

A

> 140 bpm

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5
Q

What are the signs of an unstable pt?

A 
Diaphoresis
CP
Hypotension
AMS
Pulmonary edema
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6
Q

What is considered hypotension?

A

SBP <90 mm Hg

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7
Q

What are drugs used to sedate a pt?

A

Etomidate

Propofol

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8
Q

What is the first step in treatment strategies?

A 
Monitor
IV
Oxygen
Crash cart
Defibrillator
Nurse/techs
Prepare to run full resuscitation every time
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9
Q

What does a saw tooth pattern on EKG indicate?

A

Atrial flutter

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10
Q

What does a chaotic p wave pattern on EKG indicate?

A

A fib

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11
Q

What does variable p wave morphology on EKG indicate?

A

Multifocal atrial tachycardia

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12
Q

What are the narrow regular tachycardias?

A

SVT
Atrial flutter
Wolff-Parkinson-White

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13
Q

What is a common cause of SVT?

A

Illegal drugs

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14
Q

Revert procedure

A

For SVT
Put the head of the bed at a 45 degree angle
Tell the pt to blow the plunger out of a 10cc syringe as long and hard as they can
Once pt is fatigued, lay head of bed flat, raise legs 45 degrees

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15
Q

What are vagal maneuvers to perform for SVT?

A

Plunging face into basin of ice water
Carotid massage
Valsalva maneuver
These only work 17-20% of the time, whereas revert maneuver has a 40-60% efficacy

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16
Q

How should one treat SVT if vagal maneuvers don’t work

A 
Adenosine
-Ultra short AV blocker. Rapid administration.
-Severe chest discomfort, asystole.
-Unmask atrial flutter
CCBs
-Diltiazem/verapamil
-Long-acting AV blockers
-Slows A. flutter, does not convert
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17
Q

Tx for unstable SVT

A

Cardiovert at a rate of 25-75 J

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18
Q

Atrial flutter

A

Circular rhythm in the SA node, may eventually go to AV node

Atrial rate is 300, ventricular rate is 150

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19
Q

Tx for atrial flutter

A

BBs
CCBs
-Nondihydropyradines will slow atrial flutter but will not convert it, will slow ventricular response

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20
Q

Wolff-Parkinson-White

A

Circus movement arrhythmia that goes to the AV node but also goes to an ectopic node

  • Orthodromic: clockwise direction- goes to AV node first
  • Antidromic: counterclockwise direction- goes to ectopic node first
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21
Q

Tx for Wolff-Parkinson-White

A

AV nodal blocker
Cardizem
Metoprolol

22
Q

What are the narrow and irregular tachycardias?

A

A fib
MAT- multiple atrial tachycardia
Atrial flutter with variable block

23
Q

What are the atrial and ventricular rates for A fib?

A

Atrial: 600+
Ventricular: 170-180

24
Q

Tx for A fib

A

Rate or rhythm control
-Rhythm: cardioversion/ drugs
-Rate control: Long-acting AV nodal blockers, CCBs, BBs (esmolol, metoprolol), digoxin
Cardioversion (200J) for unstable pts

25
Q

Atrial flutter with variable block

A

Grouping of the saw tooth varies in terms of ratio

Treat with AV nodal blockers to control rate

26
Q

Multifocal atrial tachycardia

A

Irregular but distinct P waves but different morphologies
Associated with COPD
Treat hypoxia

27
Q

What are the tachycardias associated with a wide complex and regular rhythm?

A

V Tach
SVT with BBB
Antidromic Wolff-Parkinson-White

28
Q

Tx of stable VTach

A 
Amiodarone
Procainamide
Lidocaine
Mg
Adenosine
29
Q

Tx of unstable VTach

A

Cardiovert (200J)

30
Q

SVT with BBB

A

An atrial tachycardia with a BBB

May stop with adenosine

31
Q

Antidromic Wolff-Parkinson-White tx

A

AV nodal blockers

32
Q

What are the irregular wide tachycardias?

A

A fib with BBB
Torsades de Pointes
WPW + A fib

33
Q

A fib with BBB

A

Most common cause of wide irregular rhythm
Treat with long-acting AV nodal blockers
Cardiovert if unstable

34
Q

Torsades de Pointes tx

A

Mg

Cardioversion (200J)

35
Q

WPW + A fib

A

Very rapid chaotic appearance rate may approach 300

36
Q

Tx for WPW + A fib

A

CARDIOVERSION
AV blockers are dangerous
Procainamide only OK agent

37
Q

HR general principles

A

The more abnl the heart rate, the more likely it is that it is responsible for the pt’s sx
The more extreme the heart rate, the more aggressive the tx will be
Whether the rate is very slow or very fast, tx decisions should be based on the appearance of the pt, not their actual hR

38
Q

First step in bradycardia management

A 
Monitor
Airway equipment
Defibrillator
Pacemaker 
Crash cart
39
Q

Ischemia as a cause of bradycardia

A

Think ACS

40
Q

Electrolytes as a cause of bradycardia

A

Think potassium

41
Q

Drug-induced causes of bradycardia

A

BBs

Others

42
Q

Endocrine causes of bradycardia

A

Hypothyroid

43
Q

General tx options for bradycardia

A

Cardioactive drugs
-Atropine 0.5 mg increments
-Epi 2-10 mcg increments
Pacing (transcutaneous/transvenous)

44
Q

Bradycardia + CP/dyspnea

A

Ischemia may cause tachycardia or bradycardia

Large MI with CHF, PE, adrenergic tone

45
Q

Bradycardia + acute coronary syndrome/MI

A

Bradycardia d/t ischemia of the conduction system or vagal response
Bradycardia with inferior MI usually narrow complex, transient, caused by vagal stimulation. Responds to atropine.
Bradycardia with anterior MI usually wide complex, caused by ischemia of the conduction system. Does not respond to atropine
Nitro may cause a reflex tachycardia (drop in preload/afterload). Contraindicated in severe bradycardia

46
Q

Bradycardia + syncope

A

3rd degree AV block (Stokes-Adams attack)

Sick sinus syndromes

47
Q

Bradycardia + overdose

A

Digoxin- ventricular arrhythmias
BBs- hypoglycemia
CCBs- hyperglycemia
Clonidine: Opioid like syndrome

48
Q

Bradycardia + AMS

A

Consider overdose vs. increased ICP

49
Q

Bradycardia + renal failure

A

Hyperkalemia

50
Q

Bradycardia + myxedema

A

Tx is thyroid replacement

Emergency Med (11 decks)

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