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Clinical Medicine II > Conduction disorders > Flashcards

Conduction disorders Flashcards

1
Q

What are some symptoms of atrial fibrillation?

A

Fatigue and exertional dyspnea, palpitations, dizziness, angina, syncope, irregularly irregular pulse, reduced exercise capacity, HOTN, insidious onset of HF, weakness – from low CO

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2
Q

What can atrial fibrillation and flutter cause that should be concerning and treated for?

A

clot that can cause a risk for stroke

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3
Q

What’s the most common chronic arrhythmia?

A

afib

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4
Q

What can cause a fib?

A

cardiac, lung diseases, valvular disease, hyperthyroidism, systemic illness, stress, alcohol, hyperadrenergic state, extreme activity

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5
Q

What are indications for hospitalization of afib?

A

Active ischemia
Heart failure
Hypotension
Difficult rate control
Evidence of organ hypoperfusion
(confusion, renal injury)

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6
Q

What are indications for rhythm control in a fib?

A

Hemodynamic instability
Failure of rate control
First episode
Young patient
CHF
Reversible cause

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7
Q

What does this ECG indicate:
irregularly irregular rhythm w/ narrow QRS, no p wave, atrial rate 300-600 BPM, ventricular 75-175 BPM

A

a fib

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8
Q

If the a fib’s if HR>100, what do you call it?

A

a fib w/ RVR

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9
Q

What is paroxysmal a fib?

A

terminates spontaneously or w/ intervention in <7 days (reoccur/not reoccur)

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10
Q

What is persistent a fib?

A

continuous >7 days

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11
Q

What is permanent Afib?

A

joint decision between clinician + patient to not puruse treatment

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12
Q

What is nonvalvular afib?

A

absence of rheumatic MS, replaced heart valve, or valve repair

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13
Q

If there is new onset a fib in a patient, what should you order?

A

thyroid study

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14
Q

What score dictates the need for anticoagulation therapy in a fib?

A

CHA2DS2VASC criteria - >2 in men or >3 in women

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15
Q

CHA2DS2-VASc criteria

A

CHF
HTN
Age>75 (2)
DM
Stroke, TIA, thrombus (2)
Vascular disease
Age 65-74
Sex (female)
total of 9

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16
Q

What are the three steps to consider maintenance of afib?

A

1) rate control (1st line for minimal w/ no symptoms) w/ BBs or CCBs
2) reversion + return to sinus rhythm w/ cardioversion if new onset or if remains symptomatic
3) a fib –> anticoagulation therapy

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17
Q

What is the ultimate backup rate control drug?

A

amiodarone

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18
Q

What rate control drug do you use in HF?

A

digoxin

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19
Q

Can you use BBs in lung disease?

A

no

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20
Q

Warfarin is for anyone with ____

A

mechanical valves, mitral disease, assistant devices

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21
Q

Why are DOACs preferred?

A

no monitoring necessary

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22
Q

How do you treat a fib>48 hours with unkown cause?

A

3 weeks of anticoagulation before cardioversion OR rule out thrombus with TEE and then 4 weeks of anticoagulation after cardioversion

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23
Q

Who needs aspirin treatment in a fib?

A

everyone who has CHD or peripheral vascular disease

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24
Q

How do you treat an unstable a fib patient?

A

IV heparin + IV rate control (beta blocker, CCB) + cardioversion (120-200 joules)

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25
Q

What can atrial flutter look like in symptoms?

A

Palpitations, dizziness,, tachycardia, fatigue, weakness, dyspnea, presyncope, hypotension, angina, reduced exercise capacity

Can have AMS

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26
Q

Are men or women more predisposed to atrial flutter?

A

men with CAD or HTN heart disease

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27
Q

What can cause atrial flutter?

A

similar to a fib

28
Q

How do you treat a flutter?

A

rate control w/ BBs or non di-CCBS
cardioversion 50-100 joules
atrial flutter ablation can be used to prevent coagulation therapy

29
Q

Can you use pharmacological cardioversion in atrial flutter?

A

no not recommended

30
Q

In who is MAT most seen?

A

COPD patients

31
Q

What’s the HR of MAT?

A

> 100 BPM

32
Q

How do you treat MAT?

A

oxygen, treatment of underlying condition, and rate control –
preserved LV function: BBs, non-di CCBs, digoxin, adenosine, IV flecainide, IV propafenone
non-LV: digoxin, diltiazem amiodarone

33
Q

How do you treat sinus tach?

A

underlying disease
BB for inappropriate sinus tach

34
Q

How do you treat sinus brady?

A

atropine if symptomatic, repeated every 3-5 min up to 3 mg

35
Q

In who is sinus brady normal?

A

athletes

36
Q

In who is sick sinus syndrome the most common?

A

fibrous tissue in older people

37
Q

How can sick sinus syndrome present?

A

sinus brady –> pause –> atrial tachy –> a fib

38
Q

Can you get sick sinus syndrome on an EKG?

A

maybe but unlikely, need Holter

39
Q

How do you treat sick sinus syndrome?

A

identify and correct factors (could be anything), symptom control, permanent pacemaker placement

symptomatic = permanent pacemaker w/ dual chamber pacing + atropine

With bradycardia + alternating ventricular tachycardia = permanent pacemaker with automatic implantable cardioverter-defibrillator (AICD)

40
Q

Sinus arrhythmia increases during ______ and decreases during _______

A

inspiration,, expiration

41
Q

What can cause a 1st degree heart block?

A

increase in vagal tone or meds like digoxin, BBs, verapamil, dilitiazem

42
Q

How do you treat a second degree Type I block?

A

asymptomatic = observation
symptomatic = atropine, epi w/ or w/o pacemaker

43
Q

How do you treat a second degree Type II block?

A

Symptomatic = atropine, pacing
Permanent pacemaker

44
Q

How do you treat a third degree block?

A

Temporary pacing, permanent pacemaker, atropine for bradycardia

45
Q

which block rarely progresses?

A

1

46
Q

How do you treat PACs?

A

none if asymptomatic

if symptomatic, beta blockers, and stopping precipitating factors

47
Q

What’s the difference between RBBBs and LBBBs?

A

left is more from disease like CAD, HTN, aortic valve, cardiomyopathy
RBBB common in people without structural defects

48
Q

3 or more consecutive PVCs

A

non sustained v tach

49
Q

How do you treat PVCs

A

asymptomatic = no tx
treat underlying cause, remove precipitating factors

symptomatic or with high PVC burden in patient w/ CHF = beta blockers
High PVCs in CHF = catheter ablation

50
Q

What are torsades de points caused from?

A

v tach, acquired or congenital, >100 BPM

51
Q

Are torsades or v fib taller waves?

A

torsades

52
Q

How do you treat torsades?

A

cardioversion, IV magnesium sulfate, discontinue drugs

53
Q

What’s the MCC of v fib?

A

ischemic heart disease

54
Q

What’s the normal BPM of v fib?

A

300

55
Q

How do you treat v fib?

A

Immediate DC defibrillation + CPR
Up to 3 sequential shocks to establish rhythm

If persists –
Continue CPR
Intubation if necessary
IV epi
Refractory -
Add IV amiodarone
Lidocaine, magnesium, procainamide

56
Q

If you are successful w/ v fib, what else do you start the patient on?

A

Continuous IV infusion of amiodarone
Implantable defibrillators (at risk)
Long term amiodarone

57
Q

What is sustained v tach?

A

> 30s + HOTN + symptomatic that leads to v fib

58
Q

What is non sustained v tach?

A

brief, self-limiting, asymptomatic (+CAD or LV dysfunction = risk for death)

59
Q

Does v tach respond to vagal manuevers or adenosine?

A

no – SVT will, so differentiate if you can’t interpret the EKG

60
Q

How do you treat sustained v tach?

A

Implant cardioverter defibrillator for all!
Mild + stable = IV amiodarone
Unstable = immediate synchronous DC cardioversion → IV amiodarone

61
Q

How do you treat nonsustained v tach?

A

Asymptomatic: treat underlying cause
Symptomatic: beta blockers (metoprolol, carvedilol), CCB (verapamil, diltiazem), antiarrhythmic drugs (amiodarone), radiofrequency ablation
Chronic = beta blocker therapy

62
Q

What are the two causes of SVT?

A

reentry with AV node + using accessory pathway

causing either orthodromic (narrow) or antidromic (wide) pathways

63
Q

In who are SVTs common?

A

younger, female, ischemic heart disease, digoxin toxicity, flutter w/ RVR, excessive caffeine/alcohol

64
Q

SVT Is usually _____ and _____

A

paroxysmal and self-limiting

65
Q

How do you treat SVT?

A

narrow = vagal maneuvers, adenosine

BBs or CCBs
unstable = direct cardioversion

66
Q

How do you treat WPW syndrome?

A

radiofrequency ablation

can do medically IV procainamide or ibutilide

67
Q

What must you avoid with WPW syndrome?

A

digoxin, BBs, CCBs, adenosine

Clinical Medicine II (11 decks)

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