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Lectures / Presentations > Cardio II Academia (Tafreshi) > Flashcards

Cardio II Academia (Tafreshi) Flashcards

1
Q

What is the sac around the heart? (Tafreshi)

A

Pericardium

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2
Q

What are the branches of the autonomic nervous system? (Tafreshi)

A
  1. Parasympathetic (Vagal)

2. Sympathetic

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3
Q

What is a holter monitor? Pronounce? (Tafreshi)

A
  1. Ambulatory EKG usually worn for hours

2. Holt (long o sound, not halt the horse)

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4
Q

What is an event monitor and implantable loop recorder? When used? (Tafreshi)

A
  1. Implantable loop recorder looks like flash drive
  2. Records when button is pushed during an episode
  3. For serious but infrequent symptoms
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5
Q

What is TTE and TEE? (Tafreshi)

A

Transthoracic echocardiography

Transesophageal echocardiography

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6
Q

What is CRT? (Tafreshi)

A
  1. Cardiac Resynchronization Therapy (CRT)
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7
Q

What is Virchow’s triad? (Tafreshi)

A
  1. Represents VTE risk factors
  2. Stasis (Immobility)
  3. Vessel injury (surgery/trauma, hx of dvt/pe)
  4. Hypercoagulability (Preg, estrogen, cancer, protein C&S deficiency, Factor V leiden)
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8
Q

When should anticoagulation be initiated in the acute setting? (Tafreshi)

A

In any patient suspected of having DVT or PE

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9
Q

What are diagnostic tools for DVT PE? (5) (Tafreshi)

A
  1. Pulmonary angiography (contrast)
  2. Ventilation-perfusion (v/q) radionuclide scan (injected and inhaled radioactive material)
  3. D-Dimer
  4. Ultrasonography (Doppler ultrasound)
  5. Contrast venography
  6. MRI CT
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10
Q

Which vit k clotting factor has the longest half life? (Tafreshi)

A
  1. Factor 2

2. Long half life explains why you need to bridge

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11
Q

What is aptt? (Tafreshi)

A
  1. Activated partial thromboplastin time

2. Also referred to ptt

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12
Q

What is a test to evaluate for peripheral arterial disease (PAD)? (Tafreshi)

A

Ankle-brachial index (ABI)

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13
Q

What is the equation for ankle-brachial index (ABI)? (Tafreshi)

A

Ankle systolic pressure (SP) / Brachial artery

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14
Q

How to interpret ankle-brachial index? (Tafreshi)

A

Lower the number the worse it is
Normal > 0.9
Severe less than 0.4

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15
Q

What is the highest risk factor for peripheral arterial disease (PAD)? (Tafreshi)

A

Smoking

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16
Q

What are the 1A recommendations for antiplatelet therapy in PAD? (Chest symptomatic PAD) (Tafreshi)

A
  1. Aspirin 81mg

2. Clopidogrel 75mg

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17
Q

What do the guidelines say about pentoxifylline (Trental) for PAD claudication? (Chest) (Tafreshi)

A

Suggest against use

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18
Q

Should warfarin be used in PAD if no other indications? (Tafreshi)

A

No

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19
Q

What is a possible treatment for Raynaud’s phenomenon? (Tafreshi)

A

Nitroglycerin ointment

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20
Q

What is the primary pacemaker for the heart? (Tafreshi)

A

Sinoatrial node (SA)

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21
Q

What are the intrinsic rates of the SA, AV, and Bundle of His / bundle branches / Purkinjie fibers? (Tafreshi)

A
  1. SA (60-100) fastest intrinsic firing rate
  2. AV (40-60)
  3. Bundle of His (20-40)
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22
Q

What is the “gatekeeper” of cardiac electroactivity? (Tafreshi)

A

Artrioventricular node

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23
Q

What is the p wave?

A

Depolarization of the atria

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24
Q

What is the P-R interval? (Tafreshi)

A

Time for impulse to conduct through atria and through AV node

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25
Q

What is the t wave? (Tafreshi)

A

Repolarization of the ventricles

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26
Q

What is ectopic activity? (Tafreshi)

A

Cells that can fire on their own

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27
Q

What does premature atrial contraction mean? Break down the term. (Tafreshi)

A
  1. Premature : before the SA node was expected to fire
  2. Atrial: From the atria
  3. Contraction
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28
Q

What is a premature junctional contraction? (Tafreshi)

A
  1. AKA premature nodal contraction

2. AV node fires on its own

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29
Q

What may a p wave look like in a premature junctional contraction? (Tafreshi)

A

Sometimes no P wave or an inverted P wave

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30
Q

What is a PVC? (Tafreshi)

A
  1. Premature ventricular contraction

2. Independent ectopic firing within ventricles

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31
Q

What does the PVC complex look like? (Tafreshi)

A

Wide and bizzare

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32
Q

What is atrial flutter? What is the role of the AV node? (Tafreshi)

A
  1. A single strong ectopic focus

2. AV node acts as a gatekeeper

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33
Q

What rhythm is a sawtooth pattern? (Tafreshi)

A

Atrial flutter

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34
Q

What is atrial fibrillation? (Tafreshi)

A
  1. Many weak etopic foci

2. Irregularly irregular

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35
Q

What is SVT? (Tafreshi)

A

SupraVentricular Tachycardia

Ectopic focus above ventricles and below the SA node

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36
Q

Are p waves clear in an SVT? (Tafreshi)

A

P waves might be hidden

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37
Q

What is ventricular tachycardia? (Tafreshi)

A

Strong ventricular ectopic focus within ventricles

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38
Q

What is ventricular fibrillation? (Tafreshi)

A

Many weak ectopic foci within ventricles

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39
Q

What are the components of electrophysiology? (Tafreshi)

A
  1. Sinoatrial (SA) node, pacemaker
  2. Atrioventricular (AV) node, gatekeeper
  3. Bundle of His (pronounced hiss)
  4. Left / Right bundle branches
  5. Purkinje fibers
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40
Q

Describe the path of circulation beginning with left ventricle (Tafreshi)

A
  1. Left ventricle
  2. Aortic valve (aortic semilunar)
  3. Aorta
  4. Systemic arteries
  5. Systemic veins
  6. Vena cava
  7. Right atrium
  8. Tricuspid valve
  9. Right ventricle
  10. Pulmonary valve (pulmonary semilunar)
  11. Pulmonary artery
  12. Lungs
  13. Pulmonary vein
  14. Left atrium
  15. Mitral valve
  16. Left ventricle
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41
Q

In general, what is a heart block? (Tafreshi)

A

Impulse is slowed or stopped at the AV junction

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42
Q

What is second degree Mobitz type 1 aka? (Tafreshi)

A

Wenckebach

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43
Q

What time do a small and large box represent? (Tafreshi)

A 
Small = 0.04 seconds
Large = 0.20 seconds
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44
Q

What are the 1A antiarrhythmics? (3) (Tafreshi)

A
  1. Quinidine
  2. Procainamide
  3. Disopyramide (dye soe PEER a mide) (Norpace)
    “1A Quality Police Department”
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45
Q

What are the 1B antiarrhythmics? (Tafreshi) (3) (Tafreshi)

A
  1. Lidocaine
  2. Mexilitine
  3. Phenytoin
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46
Q

What are the 1C antiarrhythmics? (2) (Tafreshi)

A
  1. Flecainide

2. Propafenone

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47
Q

What are the II and IV classes of Vaughan Williams antiarrhythmics? (Tafreshi)

A

Class II Beta blockers

Class IV CCB

48
Q

What is the phenylalkylamine agent? (Tafreshi)

A

Verapamil

49
Q

What is the benzothiazepine agent? (Tafreshi)

A

Diltiazem

50
Q

What is paroxysmal AF? (Tafreshi)

A

Terminates spontaneously or with intervention within 7 days

51
Q

What is persistent AF? (Tafreshi)

A

Continuous AF that is sustained >7days

52
Q

What is nonvalvuar AF? (Tafreshi)

A

Absence of

  1. Rheumatic mitral stenois
  2. Valve repair or mechanical or bioprosthetic valve
53
Q

What needs to be considered before treating for AF? (Tafreshi)

A

Is it reversible?

  1. Hyperthyroid (give PTU)
  2. Drug induced (alcohol caffeine)
54
Q

What are the two strategies for AF treatment? (Tafreshi)

A

Rate (patient remains in AF but ventricular rate is controlled)
Rhythm (patient converts to SR, chemical conversion)

55
Q

What is used in rate control for AF? How is the AV node related? (Tafreshi)

A 
BB 
CCB
Digoxin
Slow conduction through the AV node
"AV gatekeeper blocks everything"
56
Q

Which classes are used for rhythm control? (Tafreshi)

A

1A
1C
III

57
Q

Where is digoxin derived from? (Tafreshi)

A

Foxglove plant

58
Q

If someone is going to have sinus rhythm maintained is this relevant to rate or rhythm control?

A
  1. Rhythm

2. Rate the patient stays in AF

59
Q

What strategy (rate vs rhythm) prevents rapid ventricular response?

A

Rate control

60
Q

When to draw digoxin level?

A 
PO = at least 6 hours (optimally 12-24 hrs) post dose
IV = at least 4 hours post dose
61
Q

What is an important rounded level to remember with digoxin reference range?

A

1 ng/mL

62
Q

What electrolytes need to be monitored closely with digoxin?

A

K levels, hypokalemia particularly dangerous

63
Q

When is digoxin adjusted?

A
  1. Renal
  2. HF vs AF
  3. Level
64
Q

Are digoxin patients (rate control) on this for life?

A

Yes, because they remain in AF

65
Q

Why is sotalol a class III?

A
  1. K blocking

2. BB

66
Q

What is the brand name for sotalol? What does this tell you about the MOA?

A

Betapace

  1. Beta (blocker)
  2. Pace (pace the heart)
67
Q

What is the common ADR for quinidine?

A

Explosive diarrhea

68
Q

Are all forms of quinidine equivalent?

A

No, many different salts

69
Q

What are 3 general (systems) for digoxin toxicity? (Tafreshi)

A
  1. GI
  2. CNS
  3. CV
70
Q

Are all forms of quinidine equivalent? (Tafreshi)

A

No, many different salts

71
Q

What are two important cardiac drug-drug interactions with quinidine? (Tafreshi)

A
  1. Digoxin (increased levels)

2. Warfarin (increased anticoagulant, INR unchanged)

72
Q

What is a danger of quinidine use in AF? What can be done to prevent? (Tafreshi)

A
  1. May increase ventricular response. It can turn AF to VF

2. Give BB, nonDHP CCB before administration, if given after it is too late.

73
Q

What EKG changes occur with quinidine? (Tafreshi)

A

QT prolongation

74
Q

What is a reference range for quinidine?

A

2-5 mcg/mL

75
Q

What is an important ADR for procainamide? (Tafreshi)

A

Systemic lupus erthematosus (SLE)

76
Q

How to check for SLE?

A

Anti nuclear antibodies

77
Q

What is an important counselling point for procainamide (Procan SR)? (Tafreshi)

A

Ghost tablet, may appear in feces

78
Q

What is the procainamide reference range? (Tafreshi)

A 
PA = 5mcg/mL
NAPA = 15 mcg/mL
79
Q

What is the reference range for disopyramide? (Tafreshi)

A

5 mcg/mL

80
Q

What patient will not be happy with disopyramide (Norpace)? (Tafreshi)

A
  1. Older male patient with BPH
  2. Anticholinergic side effects (urinary retention, blurred vision)
  3. Nickname “no-piss”
81
Q

What is the difference for indications of IA, IB, and IC antiarrhythmics? (Tafreshi, AF 2014)

A
  1. IA and IC = Supraventricular and Ventricular

2. IB = Ventricular arrhythmia (missing in AF guidelines)

82
Q

May lidocaine be given via endotracheal route? (Tafreshi)

A

Yes, use 2x the dose

83
Q

What is the IV:PO conversion for lidocaine? (Tafreshi)

A

No PO form available for arrhythmia (PO viscous available)

Mexiletine theoretical PO option

84
Q

What is the IV:PO conversion for disopyramide (Norpace)? (Tafreshi)

A

Only PO available

85
Q

Is lidocaine renal or hepatically metabolized?

A

Hepatic

86
Q

What is the relation of propafenone and beta blockers? (Tafreshi)

A
  1. Relative CI
  2. Structurally similar to propranolol (non-selective)
  3. Best to avoid in asthma
87
Q

What are two cardiac drug-drug interations with amiodarone? (Tafreshi)

A

May need to lower digoxin and warfarin doses by half

88
Q

When is amiodarone a DOC? (Tafreshi)

A

HF patients who need an antiarrhythmic

89
Q

Can you crush amiodarone? (Tafreshi)

A

Yes

90
Q

What is the distribution half life of amiodarone? (Tafreshi)

A

~5 days

91
Q

Is amiodarone found in breast milk? (Tafreshi)

A

Yes, much higher concentrations

92
Q

If amiodarone has such a long half life why BID-TID? (Tafreshi)

A

Amiodarone can be barfogenic

93
Q

What type of patient may be given slow IV amiodarone titration? (Tafreshi)

A
  1. V tach with a pulse

2. Afib chemical

94
Q

What is the ACLS dose of amiodarone? (Tafreshi)

A

300mg IV push

95
Q

What is a structural difference between dronedarone and amiodarone? (Tafreshi)

A

Dronedarone has no iodine group

96
Q

What is an important ADR for procainamide? (Tafreshi)

A

Systemic lupus erthematosus (SLE)

97
Q

How to check for systemic lupus erthematosus (SLE)? (Tafreshi)

A

Anti nuclear antibodies

98
Q

What are potential advantage / disadvantage of dronearone compared to amiodarone? (Tafreshi)

A
  1. Supposed to be less toxic

2. Does not work as well

99
Q

What is the BBW for dronedarone? (Tafreshi)

A 
CI in NYHA class II-III 
Recent HF decompensation
100
Q

Is sotalol selective or non-selective BB? (Tafreshi)

A

Non-selective

101
Q

What is absolutely essential for monitoring for ibutilide (Corvert)? What is the concern? (Tafreshi)

A
  1. Continuously EKG during administration
  2. Infusion are over ~10 minutes and may be repeated
  3. QT prolongation, torsades de pointes
102
Q

What is the indication for dofetilide? (Tafreshi)

A

Maintenance and conversion of AF or Aflutter

103
Q

What is the MOA for dofetilide? (Tafreshi)

A

K channel blocker

104
Q

What is a scary ADR for adenosine? (Tafreshi)

A

Expect a very short-lasting asystole

105
Q

What does it mean if adenosine does not cause asystole? (Tafreshi)

A

Did not work

106
Q

What is regadenoson (Lexiscan)? (Tafreshi)

A

Not for arrhythmia

107
Q

What is the DOC and treatment of choice for torsades? (Tafreshi)

A 
DOC = magnesium
Treatment = Shock
108
Q

What is the max rate of infusion for IV magnesium? (Tafreshi)

A

150mg / min
1.5g = 10 mins
Only for hypomagnesium, for torsades = push over 1 min

109
Q

What does AHA/ACC recommend based on CHADSVAS 1 and 2? (Tafreshi)

A 
1 = nothing
2 = anticoagulate
110
Q

When is electiral cardioversion indicated in a fib? (Tafreshi)

A
  1. Hemodynamically unstable

2. SBP

111
Q

What is the HR goal for rate control in AF? (Tafreshi)

A

1.

112
Q

Can amiodarone be used for rate control? (Tafreshi)

A

Yes when other rate agents are CI or unsuccessful

BB CI in severe asthma, CCB severe hypotension

113
Q

Can amiodarone be used for rate control? (Tafreshi)

A

Yes when other rate agents are CI or unsuccessful

BB CI in severe asthma, CCB severe hypotension

114
Q

What agents can be used for pharmacologic cardioversion? (Tafreshi)

A
  1. Flecainide IC
  2. Propafenone IC
  3. Dofetilide III
  4. Ibutilide III
  5. Amiodarone III
115
Q

Why can’t dofetilide be initiated outpatient? (Tafreshi)

A

QT prolongation

116
Q

What agents are used to maintain SR? (Tafreshi)

A
  1. Amiodarone III
  2. Dronedarone III
  3. Dofetilide III
  4. Sotalol III
  5. Flecainide IC
  6. Propafenone IC
117
Q

What are your options for rhythm control in AF with HF? (Tafreshi)

A
  1. Amiodarone

2. Dofetilide

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