cardiology Flashcards
SVT
pharm management step up
first second third last measure pharm fails
- adenosine
- ca channel blocker
- digoxin or IV metoprolol
all fail flip dc cardioversion
SVT
prevention pharm treatment
failure of pharm to prevent next step
- ca channel blocker
2. symptomatic or recurrent radiofrequency catheter ablation
SVT
mechanism of treatment physical and pharm
stimulate vagus delay AV node rentry physical
pharm treatment delay av node rentry
wolf parkinson syndrome (WPS)
- acute management + mechanism
- contraindicated drugs and pathophysio
- chronic management
- amiodaron (class 3 antiarrythmic) and procaimide class 1 antiarrythmic block k+ channels prolong repol –> prolonging qt. increase time till ventricular depol
- digoxin and CCB c/I b.c block av node / regular pathway increase accessory pathway make arrhythmia worse
- chronic radiofrequency catheter ablation curative
WPS
signs an symptoms
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
SVT unstable MNGT
cardioversion
Atrial fibrillation MNGT
- rate control (before cardioversion) 60-100 target
- anticoagulation 3 weeks ( if necessary)
- cardioversion
atrial fibrillation anticoagulation
- indication
- reasoning for treatment
- method of treatment
- INR goal range
- > 48 hours onset Afib or onset unknown
- prevention of embolization during cardioversion high risk prevent cerebovascular accident
- 3 weeks before cardioversion and 4 weeks after cardioversion
- INR 2-3
atrial fibrillation anticoagulation risk assessment
risk assessment c- congestive heart failure or CAD-1 h- hypertension -1 a- >75 years-1 d- DM-1 s-stroke-2
Anticoagulation drug TX indication per chad score
<1 - aspirin alon
< or equal 2 –> warfarin, dabigatran, xa inhibitors
no bridging
Afib anticoagulation warfarin indication
c/I to warfarin use in AFIb
indications 1. metal valve must bridge 2. valve disease (mitral stenosis) must bridge C/I Major bleed 1. intracranial hemorrhage 2. bleeding requiring transfusion
Afib immediate synchronized cardioversion indication
1.unstable hemodynamically hypotension confusion worsening symptoms CHF chest pain 2.<48 hours 3. first ever Afib
Afib rate control drugs and special dictions
- beta blocker - ex grave disease
- ca blocker - asthma, migraine
- digoxin or amiodarone - LV dysfunction, hypotension
rhythm control
Afib when is pharm conversion indicated
list drugs used
when electrical cardioversion fails or is not
feasible: Parenteral ibutilide, procainamide, flecainide, sotalol, or amiodarone
are choices.
multifocal atrial tachycardia MNGT
treat underlying disease -copd oxygenation- CCB drug of choice BB C/I b.c possible bronchoconstricts digoxin - LV non function
sick sinus rhythm treatment
venous pacemaker
PAC and PVC indication for treatment and drug used to treat
Both -Treat if patient is symptomatic
both - treat w BB
- Patient diagnosed with PVC next step
2. who benefits form ICD
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
Vfibrillation /pluseless Ventricular Tachycardia - management
< 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
Ventricular Fibrillation management after successful
cardioversion
continue IV amiodarone drip
implantable defibrillator
Torsades de point MNGT
mg+ sulfate
Brugda syndrom
ICD
VT with pulse management
- unstable VT w pulse
- stable VT w puls
- unstable w pulse immediate synchronous cardioversion and follow with amiodarone
- sable with pulse -
- define Nonsustained VT
1.Brief, self-limited runs of VT, Usually asymptomatic
- sustained VT define
2.
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
VT prognosis
good- if no underlying heart disease
poor - after MI
Sustained VT MNGT
- stable
- unstable stable
- long term treatment
- 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) - Hemodynamically unstable patients or patients with severe symptoms •
- Immediate synchronous DC cardioversion
- Follow with IV amiodarone to maintain sinus - Ideally, all patients with sustained VT should undergo placement of an ICD, unless EF is normal (then consider amiodarone).
Sustained VT MNGT
- asymptomatic or no underlying heart disease
- HX of MI, LV dysfunction, symptomatic, or heart disease
- second line treatment
- If no underlying heart disease and asymptomatic, do not treat. These patients
are not at increased risk of sudden death. - 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. - Pharmacologic therapy is second-line treatment. However, amiodarone has the
best results of all of the antiarrhythmic agents.
2nd degree AV block type II MNGT
3 degree AV block
transvenous pacemaker - no atropine C/I
first degree AV block
2nd degree Av block
sinus Bradycardia
atropine
beign conditions
Sites of block
1,2 degree type I and II degree heart block
first degree and 2nd degree type I –> located AV node
2nd degree type II- located in his purkinjie fibres
- PEA/asystole
2. define PEA
non shockable rhythm
cpr for 2 min or 5 rounds and epinephrine every 2-3 minutes
- Any rythmn on ECG without a pulse
