Cardiology

Question 1

Osborn waves

Answer 1

J point elevation in the precordial leads seen in hypothermia

Question 2

arrythmias seen in hypothermia

Answer 2

bradyarrythmia, afib, osborn waves

Question 3

staging of hypothermia

Answer 3

swiss stage I -IV

Question 4

why do you warm the trunk before the limbs in hypothermia?

Answer 4

warming the limbs cause cold acidemic blood to go to heart and can cause arrythmias

Question 5

passive leg raise, threshold for SV

Answer 5

> 10% increase in SV with passive leg raise has a high positive and negative predictive value for volume responsiveness

Question 6

MOA of milrinone

Answer 6

phosphodiesterase-3 inhibitor. predominantly is a vasodilator but does have ionotopic effects.

Question 7

Nitric oxide MOA

Answer 7

a potent vasodilator but does not have any inotropic effects

Question 8

phrenic nerve injury during CABG?

Answer 8

20% unilateral, 1 % bilateral. Can be from direct trauma, ishcemic injury from lack of flow to the vaso nervorum, cold induced injry

Question 9

AV dissociation in complete heart block?

Answer 9

regular atrial and ventricular rhythms at different rates

Question 10

CHB in anterior MI, what does it mean?

Answer 10

usually indicated more myocardium is involved and is distal to AV node. This correlates with a higher mortality.

Question 11

CHB in inferior MI, what does it mean?

Answer 11

often a result of inc vagal tone and will be transient

• if the block is above the His then the escape rythym is typically stable and will be narrow QRS
• if below the bundle then they may become HD unstable

Question 12

pregnancy SCAD treatment

Answer 12

usually supportive with single AP therapy. PCI not ideal because could worsen dissection

Question 13

pregnancy SCAD

Answer 13

likely 2/2 hormonal changes of the arterial media and changes in CO during pregnancy

Question 14

MOA of BB in afib?

Answer 14

blocking sympathetic input

Question 15

MOA of CCB in afib?

Answer 15

block L type calcium channels and block block calcium influx thereby slowing AV nodal conduction by reducing the action potential

Question 16

when do you not use CCB in afib?

Answer 16

patients with LV dysfunction and decompensated HF because of the negative ionotropic effects

Question 17

definition of Peripartum CM?

• incidence?
• Risk factors?

Answer 17

• development of heart failure in the latter weeks of pregnancy, after 36, or 1-6 months postpartum
• approximately 1:3000
• gestational HTN, preeclampsia, african, advanced maternal age, obesity, lower socioeconomic class

Question 18

Atrial Fibrillation
paroxysmal?
persistent?

Answer 18

• <1 week

- >1week

Question 19

how would you shock someone out of acute unstable afib?

Answer 19

• synchronized cardioversion

120-200J

Question 20

controlling afib in heart failure?

Answer 20

amiodarone, digoxin

Question 21

if there is an accessory pathway how to control afib?

Answer 21

no AV nodal blocking agent

Question 22

pharmacologic cardioversion for afib?

Answer 22

ibutilide

(concern for torsades), amiodarone, procainamide

Question 23

afib >48 hours, elective CV?

Answer 23

rate control, AC for 3 weeks, then elective DC CV followed by 4 weeks AC

Question 24

afib>48 hrs, emergent?

Answer 24

TEE, bolus AC then DC CV followed by oral AC for 3 weeks

Question 25

Multifocal Tachycardia?
tx?
cardiovert?

Answer 25

irregularly irregular, differing p waves

• treat underlying etiology
• can control rate with BB, CCB
• WILL not respond to cardioversion

Question 26

AV node reentry tachycardia?
respond to adenosine?
tx?

Answer 26

regular tachycardia, development of a slow pathyway in the AV node, causing a circle through both fast and slow pathways

• yes because blocks through AV node
• BB, CCB, dig, amio, vagal, DC cardioversion, pacing

Question 27

WPW?

reason for sudden death?

Answer 27

• accessory pathway
• reentry circuit, AV-> Vent and then back up the accessory pathway and back down
• slurred, widened QRS, delta wave
• afib with rapid vent conduction with conduction over accessory pathway, can lead to vfib

Question 28

tx for WPW?

Answer 28

• don’t use AV nodal agent alone
• use with slowing the accessory pathway
• procainamide plus BB
• DC cardioversion

Question 29

atrial flutter pathophys

tx?

Answer 29

• sawtooth pattern in inferior leads
• due to reentry circuit spinning around tricuspid valve
• DC CV at 50-100J
• atrial pacing

Question 30

what is a fusion beat?

Answer 30

• see during VT
• every once in a while a sinus conduction happens in the other bundle opposite of the side of the ventricular focus where the VT is occuring

Question 31

SVT with Abberancy?

Answer 31

• wide complex tachycardia
• conducts to ventricle, when it hits the right and left bundle it gets delayed through one of the bundles and becomes a wide complex

Question 32

Ventricular tachycardia features?

Answer 32

• fusion/capture beats
• QRS concordance in the precordial leads
• AV dissociation

Question 33

features that support SVT with abberancy in WCT?

Answer 33

• stops with vagal tone
• rate dependent, narrow complex that speeds up and becomes widened
• alternating bundle branch blocks

Question 34

Ashman phenomenon?

Answer 34

afib and then wide complex beats start occurring

Question 35

VT with pulse unstable?

Answer 35

• if wide regular syn DC 100J

- wide irregular: defib 200J

Question 36

VT with pulse and stable?

Answer 36

• can use adenosine at first to see if its SVT with aberrancy

Question 37

prolonged QT and torsades, what is the tx?

Answer 37

• Mag first

- can use isuprel