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internal medicine mb step 2 > cardiology > Flashcards

cardiology Flashcards

1
Q

SVT
pharm management step up
first second third last measure pharm fails

A
  1. adenosine
  2. ca channel blocker
  3. digoxin or IV metoprolol

all fail flip dc cardioversion

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2
Q

SVT
prevention pharm treatment
failure of pharm to prevent next step

A
  1. ca channel blocker

2. symptomatic or recurrent radiofrequency catheter ablation

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3
Q

SVT

mechanism of treatment physical and pharm

A

stimulate vagus delay AV node rentry physical

pharm treatment delay av node rentry

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4
Q

wolf parkinson syndrome (WPS)

  1. acute management + mechanism
  2. contraindicated drugs and pathophysio
  3. chronic management
A
  1. amiodaron (class 3 antiarrythmic) and procaimide class 1 antiarrythmic block k+ channels prolong repol –> prolonging qt. increase time till ventricular depol
  2. digoxin and CCB c/I b.c block av node / regular pathway increase accessory pathway make arrhythmia worse
  3. chronic radiofrequency catheter ablation curative
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5
Q

WPS

signs an symptoms

A 
delta wave
short pr interval 
wide qrs b.c of delta wave
worsening with digoxin or CCB goes into ventricular tachycardia 
SVT alternating with VT
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6
Q

SVT unstable MNGT

A

cardioversion

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7
Q

Atrial fibrillation MNGT

A
  1. rate control (before cardioversion) 60-100 target
  2. anticoagulation 3 weeks ( if necessary)
  3. cardioversion
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8
Q

atrial fibrillation anticoagulation

  1. indication
  2. reasoning for treatment
  3. method of treatment
  4. INR goal range
A
  1. > 48 hours onset Afib or onset unknown
  2. prevention of embolization during cardioversion high risk prevent cerebovascular accident
  3. 3 weeks before cardioversion and 4 weeks after cardioversion
  4. INR 2-3
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9
Q

atrial fibrillation anticoagulation risk assessment

A 
risk assessment
c- congestive heart failure or CAD-1
h- hypertension -1
a- >75 years-1
d- DM-1
s-stroke-2
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10
Q

Anticoagulation drug TX indication per chad score

A

<1 - aspirin alon
< or equal 2 –> warfarin, dabigatran, xa inhibitors
no bridging

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11
Q

Afib anticoagulation warfarin indication

c/I to warfarin use in AFIb

A 
indications 
1. metal valve must bridge
2. valve disease (mitral stenosis) must bridge
C/I Major bleed
1. intracranial hemorrhage 
2. bleeding requiring transfusion
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12
Q

Afib immediate synchronized cardioversion indication

A 
1.unstable hemodynamically
hypotension 
confusion 
worsening symptoms 
CHF
chest pain
2.<48 hours
3. first ever Afib
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13
Q

Afib rate control drugs and special dictions

A
  1. beta blocker - ex grave disease
  2. ca blocker - asthma, migraine
  3. digoxin or amiodarone - LV dysfunction, hypotension
    rhythm control
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14
Q

Afib when is pharm conversion indicated

list drugs used

A

when electrical cardioversion fails or is not
feasible: Parenteral ibutilide, procainamide, flecainide, sotalol, or amiodarone
are choices.

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15
Q

multifocal atrial tachycardia MNGT

A 
treat underlying disease -copd
oxygenation- 
CCB drug of choice 
BB C/I b.c possible bronchoconstricts
digoxin - LV non function
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16
Q

sick sinus rhythm treatment

A

venous pacemaker

17
Q

PAC and PVC indication for treatment and drug used to treat

A

Both -Treat if patient is symptomatic

both - treat w BB

18
Q
  1. Patient diagnosed with PVC next step

2. who benefits form ICD

A

1.work up for underlying heart disease

2.patient with underlying structural Heart disease have increase risk Vfib - sudden cardiac death
work up patient with electrophysiology
benefit from ICD

19
Q

Vfibrillation /pluseless Ventricular Tachycardia - management

A

< less than 5 minutes immediate unsychronized defibrillation/ DC cardioversion 3 times

> 5 minutes or unwitnessed - start cpr 2 minutes then check pulse, rhythm shock if necessary. give epinephrine during cpr 1mg and there after every 3-5 min
then defibrillate give 3 shocks
on 3rd shock if no change give amiodarion 300 mg iv with epinpephrine continue

20
Q

Ventricular Fibrillation management after successful

cardioversion

A

continue IV amiodarone drip

implantable defibrillator

21
Q

Torsades de point MNGT

A

mg+ sulfate

22
Q

Brugda syndrom

A

ICD

23
Q

VT with pulse management

  1. unstable VT w pulse
  2. stable VT w puls
A
  1. unstable w pulse immediate synchronous cardioversion and follow with amiodarone
  2. sable with pulse -
24
Q
  1. define Nonsustained VT
A

1.Brief, self-limited runs of VT, Usually asymptomatic

25
Q
  1. sustained VT define

2.

A

Sustained VT (persists in the absence of intervention)
• Lasts longer than 30 seconds and is almost always symptomatic
• Often associated with marked hemodynamic compromise (i.e., hypotension)
and/or development of myocardial ischemia
• A life-threatening arrhythmia
• Can progress to VFib if untreated

26
Q

VT prognosis

A

good- if no underlying heart disease

poor - after MI

27
Q

Sustained VT MNGT

  1. stable
  2. unstable stable
  3. long term treatment
A
  1. Hemodynamically stable patients with mild symptoms and systolic BP > 90 —pharmacologic therapy
    • IV amiodarone drug of choice*** ,or IV procainamide, or IV sotalol (over IV lidocaine)
  2. Hemodynamically unstable patients or patients with severe symptoms •
    - Immediate synchronous DC cardioversion
    - Follow with IV amiodarone to maintain sinus
  3. Ideally, all patients with sustained VT should undergo placement of an ICD, unless EF is normal (then consider amiodarone).
28
Q

Sustained VT MNGT

  1. asymptomatic or no underlying heart disease
  2. HX of MI, LV dysfunction, symptomatic, or heart disease
  3. second line treatment
A
  1. If no underlying heart disease and asymptomatic, do not treat. These patients
    are not at increased risk of sudden death.
  2. If the patient has underlying heart disease, a recent MI, evidence of left ven-
    tricular dysfunction, or is symptomatic, order an electrophysiologic study: If it
    shows inducible, sustained VT, ICD placement is appropriate.
  3. Pharmacologic therapy is second-line treatment. However, amiodarone has the
    best results of all of the antiarrhythmic agents.
29
Q

2nd degree AV block type II MNGT

3 degree AV block

A

transvenous pacemaker - no atropine C/I

30
Q

first degree AV block
2nd degree Av block
sinus Bradycardia

A

atropine

beign conditions

31
Q

Sites of block

1,2 degree type I and II degree heart block

A

first degree and 2nd degree type I –> located AV node

2nd degree type II- located in his purkinjie fibres

32
Q
  1. PEA/asystole

2. define PEA

A

non shockable rhythm
cpr for 2 min or 5 rounds and epinephrine every 2-3 minutes

  1. Any rythmn on ECG without a pulse

internal medicine mb step 2 (7 decks)

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