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Clin Med-Cardio pt 2 > Clinical arrhythmia lecture > Flashcards

Clinical arrhythmia lecture Flashcards

1
Q

Some antiarrhythmics (Class 1A, 1C, Class III), erythromycin, antifungals, tricyclic antidepressants

…can cause?

A

Prolonged QT interval

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2
Q

Atrial fibrillation with controlled or slow rate in absence of meds that slow AV conduction.

A

Sick sinus syndrome variation

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3
Q

Brady-Tachy Syndrome- paroxysmal atrial tachyarrhythmias accompanied by sinus node dysfunction and symptomatic bradycardia.

A

Sick sinus syndrome variation

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4
Q

Presence of symptoms clearly related to sinus node dysfunction (pauses) proven by ECG.
40% will have concomitant AV Node dysfunction, heart block.

A

Sick sinus syndrome

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5
Q

Most common cause of sick sinus syndrome?

A

AGING

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6
Q

Sinus node dysfunction
AV node dysfunction

…treatment

A

permanent pacemaker

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7
Q

Sick sinus syndrome tx

A

step 1…eliminate offending drug (if applicable)

step 2..pacemaker

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8
Q

PAC precipitating factors

A

ETOH
caffeine
adrenergic stimulation

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9
Q

*Paroxysmal and persistent forms.**
May be seen in healthy individuals (5%) without HD
*can be precipitated by emotional stress, use of stimulants, following surgery, or with acute ETOH intoxication (“holiday heart”).
*Also occurs in absence of a precipitant

A

A fib

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10
Q

95% of A fib cases seen in the presence of…

A

underlying cardiac or pulmonary pathology

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11
Q

_____ most often seen in valvular, hypertensive and coronary heart disease
*frequently develops in adults with atrial septal defects

A

A fib

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12
Q

Irregularly irregular rhythm
atrial depol 400-600/min

*if new/untreated…ventricular rate tachycardia (often 120-180)

A

A fib

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13
Q

If rate continuously exceeds 200 bp, consider A fib with…

A

WPW

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14
Q

First priority when assessing A fib patient….

A

ASSESS HEMODYNAMIC STABILITY

most yes. if no…cardioversion

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15
Q

Must worry about thromboembolic if in A fib for longer than….

A

48-72 hours

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16
Q

Diagnostic test that all new onset A fib patients must have

A

Cardiac ultrasound (echo)

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17
Q

If hemodynamically stable, initial goal for a fib tx

A

Rate control

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18
Q

IV _____ is best for rapid rate control in ED for A fib

A

Diltiazem

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19
Q

Oral diltiazem, verapamil, or beta blockers

A

Best for chronic rate control of A fib

20
Q

If A fib present for longer than 72 hours…

A

MUST FULLY ANTICOAGULANT

no cardioversion until 3 weeks of anti coagulation

21
Q

2 chronic A fib management strategies

A
  1. rhythm control

2. rate control

22
Q

cardioversion to NSR+ drug Rx to maintain sinus rhythm→↑ CO/function, but side effects of meds, recurrences of Afib.

A

Rhythm control strategy of A fib

23
Q

leave in afib, control ventricular rate + anticoagulate (warfarin* for most patients)

A

Rate control strategy of A fib

24
Q

CHADS2 or CHADS VAS

A

used to calculate risk of stroke

25
Q

If a pt with a fib has a CHADS score of 0…

A

Can leave in a fib, don’t need to anticoagulate

26
Q

Definitive treatment for A fib rhythm control…

A

Ablation with surgery or catheter

65-90% success

27
Q

This drug class appears to increase risk of developing a fib or a flutter

A

NSAIDs

28
Q

Underlying heart disease always present.
**Paroxysmal and persistent forms.
Embolization risk less than Afib but occurs.

*Rate usually 240-350; ventricular rate most often 1/2 the flutter rate; less stable hemodynamically; difficult to slow with meds.

A

A flutter

29
Q

Most effective tx for A flutter

A

DC cardioversion

often need meds to prevent recurrence

30
Q

If you see a 4:1 atrial flutter..is this person already being treated?

A

Most likely yes

31
Q

Re-entry is responsible for vast majority of cases
Seen in any age group, especially healthy young adults.
***Narrow complex, regular tachycardia, rate usually 150-220.
**P waves usually not identifiable; may come after QRS

A

PSVT

32
Q

2 pathways of AV node

A

Alpha and beta

33
Q

Requires dual AV nodal (α & ß pathways) that can conduct in either direction.
**Initiated by PAC conducted antegrade down one (β) AV pathway; if conduction slow enough to allow previously refractory other (α) pathway time to recover, impulse will be conducted retrograde back through the AVN initiating a re-entry circuit

A

PSVT

34
Q

DOC for PSVT

A

Adenosine

35
Q

Interventions that increase vagal tone (e.g. carotid message or valsalva) may abruptly terminate the rhythm.

A

PSVT

36
Q

Selective ablation of AV node can be tx for

A

PSVT

37
Q

Accessory A-V bypass tract (Kent Bundle) allows conduction to ventricles as alternative to the AV node.
ECG findings: Short PR interval and Delta waves

A

WPW

38
Q

Can you use Adenosine, ß-Blockers, Diltiazem, Verapamil in a WPW pt with A fib or A flutter?

A

NO!!!!

can use Procainamide or Amiodarone

39
Q

Lidocaine will slow conduction through…

A

kent bundle! (in WPW)

40
Q

Radio Frequency Ablation: Catheter ablation of the bypass tract is effective (90%) and curative. Treatment of choice for most ____ patients.

A

WPW

41
Q

Most patients developing VF within 1st 48 hrs of an acute MI have a _____ prognosis if successfully resuscitated

A

good long term

42
Q

Resuscitated VF unassociated with acute MI has a very high recurrence rate (> 30% recur within the first year following the initial event), and carries a….

A

very poor prognosis

*tx with ICD

43
Q

most common cause of sudden cardiac death

A

V fib

44
Q

V fib sometimes occurs following administration of antiarrhythmic drugs - especially in patients with….

A

prolonged QT interval

45
Q

prominent jugular pulsation and palpable parasternal lift

  • harsh systolic murmur best heard at second and third left intercostal space
  • radiates to left shoulder
  • early systolic sound precedes the murmur during expiration
A

Pulmonic stenosis

Clin Med-Cardio pt 2 (11 decks)

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