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CMC > Ch 6 Arrhythmias & Cardiac Arrest > Flashcards

Ch 6 Arrhythmias & Cardiac Arrest Flashcards

1
Q

Management of A-fib

A

Rate control v rhythm conversion
Chronic A-fib: thrombus at L atrium / L atrial appendage. NEVER want to convert unless you confirm via TEE there is no thrombus present
Medications: Amiodarone (safer for pt with rEF) / BB / CCB -diltiazem ( caution with rEF) / Digoxin / Anticoagulation if sustained A-fib

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2
Q

Amiodarone

A

Indications: atrial or ventricular arrhythmias
Effects: K+ channels in myocardial cells
Adverse Effects: Monitor QTc prolongation, bradycardia, hypotension
Long Term: toxicity, pulmonary fibrosis, neuro or hepatic injury, thyroid dysfunction
Long Half Life- 58 days b n

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3
Q

Digoxin effects & uses

A

Increases myocardial contractility, slows conduction impulse through the AV node
Control ventricular rate in A-fib / a-flutter
Best suited for patients with HF / A-fib

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4
Q

Digoxin can cause almost any ____?

A

Arrhythmia

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5
Q

_____ increases risk of digoxin toxicity

A

Hypokalemia

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6
Q

Meds that increase or decrease the effects of digoxin

A

Increases Dig levels : Amiodarone (reduce digoxin dose by 1/2 when amiodarone started) & PPIs

Decrease: Antacids - decreases bioavailability of Dig

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7
Q

Signs of Digoxin Toxicity

A

Bradycardia
Prolonged PR Interval - 1st degree AV block
ST segmented depression
Prolong QT interval
Vision changes, see yellow halos
N/V
Dizziness

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8
Q

Stable vs Unstable SVT

A

Stable - VAD
V - Vagal Manuevers
A - Adenosine 6 / 12 x2 every 1-2 minutes
D - Diltiazem or BB

Unstable - synchronized cardioversion

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9
Q

Adenosine effects

A

Depresses AV node conduction & SA node activity for SVT

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10
Q

Adenosine half life

A

<10 seconds

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11
Q

Adenosine adverse effects

A

Momentary asystole or AV block, facial flushing, hypotension, nausea

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12
Q

Adenosine Contraindications

A

Heart blocks / WPW with wide QRS, asthma/bronchospasms

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13
Q

Which leads best for differentiating SVT vs ventricular origin?

A

V1 & V6 - positive concordance in the precordial leads shows more likely VT than SVT

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14
Q

Drug of choice for monomorphic wide complex tachycardia?

A

Lidocaine

*** Since 2010 guidelines - adenosine 6 mg IV may repeat dose

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15
Q

What uses abnormal conduction pathway between the atria & ventricles often using the Bundle of Kent accessory pathway? Accessory pathways conduct faster than the AV node?

A

Wolfe-Parkinson-White

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16
Q

What has a delta wave - slurred upstroke in the QRS and a short PR interval <0.12 sec?

A

WPW

17
Q

What is the treatment for WPW?

A

Antiarrhythmic medications to slow conduction
- BB often used
- Flecainide, propafenone, sotalol, or amiodarone

18
Q

What medications are avoided in WPW?

A

Digoxin, calcium channel blockers & adenosine. These AV nodal blocking agents may cause VT

19
Q

Short term treatment of WPW?

A

Cardiovert if unstable

20
Q

Long term treatment of WPW?

A

EP consult for ablation of the accessory pathway

21
Q

IA Prolongs repolarization - used in atrial / ventricular dysrhythmias. QT prolongation

A

Quinidine (Cardioquin)
Procainamide

22
Q

1B Shortens action potential duration for ventricular dysrhythmias

A

Lidocaine (xylocaine)
Tocainamide (Tonocard)
Mexiletin (Mexitil)

23
Q

1C Blocks Na+ Channels for ventricular dysrhythmias

A

Flecainamide (tambocor)
Propafenone (Rhythmol)

24
Q

II Decreases HR & SA node automaticity beta blocker for atrial dysrhythmias & SVT

A

Propanolol (Inderal)
Esmolol (Brevibloc)

25
Q

III Blocks K+ channels, slows conduction for atrial / ventricular dysrhythmias,

A

Amiodarone (Cordarone)
Bretylium (Bretylol)
Sotalol (Betapace)

26
Q

IV Calcium channel antagonist for atrial tachycardia / atrial flutter

A

Verapamil (Calan)
Diltiazem (Cardizem)

27
Q

Other class of antiarhythmic thats slows AV node conduction, depresses SA node for atrial flutter and SVT

A

Digoxin (Lanoxin)
Adenosine (Adenocard)

CMC (3 decks)

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