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Assessment 2.5 > Day 3 Cardiology- Arrythmias > Flashcards

Day 3 Cardiology- Arrythmias Flashcards

1
Q

What is heart rate? What is tachycardia vs bradycardia?

What is sinus rhythm? What is automaticity?

What is a bradyarrythmia?

A

of beats per minute(or unit of time). Tachy >120, Brady <60. Both can be considered an arrythmia.

Normal rhythm. Ability of cardiac muscle to discharge an electrical current without an external pacemaker.

failure of impulse initiation(low HR), failure of propogation from atrium to ventricle causing dropped beats(heart block)(AV node or his perkinje abnormality)

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2
Q

What is tachyarrythmia?

What is automatic tachycardia?

What is a class 1 MOA?

A

enhanced automaticity, triggered automaticity, reentry.

enhanced(accelerated SA node) and triggered automaticity(normal until 3 and 4)

Na channel blockade,increase refractory period(interruption of tachycardia to reentry), increase action potential (torsades).

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3
Q

What are the class 1a drugs?

What are side effects?

Do all class 1a and 1c drugs cause qt prolongation and torsades?

A

Disopyramide, Procainamide, Quinidine. Sodium AND potassium inhibitors

Disopyramide(anticholinergic,GI, torsades, HF), Procainamide–>low BP and torsades, Quinidine–>GI, Low bp, torsades, hepatitis, thrombocytopenia, hemolytic anemia, anticolinergic

Yes

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4
Q

What are the class 1b drugs?

What are the side effects of lidocaine and mexiletine?

What are the class 1c drugs? What kind of side effects do they cause?

A

Lidocaine(IV), Mexiletine(oral). Used more for ventricular arrhytmias. Weak inhibitors.

Sedation, Paresthesia, Seizures, GI, Sinus arrest(lido), ventricular arrythmias(mexelitine).

Flecainaide(beta blocking properties), Propafenone. Beta blocker type.

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5
Q

What are your class 2 arrythmia drugs?

What to know about class 2 drugs?

What to know about class 2 moa?

A

Beta blockers

Used for tachyarrthymias, slow ventricular response in atrial arrhytmias, slow or prevent remodeling in heart failure.

Potassium channel blockade, increased refractory period, increased action potential duration.

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6
Q

What are your class 3 agents?

Does dofetilide need to be adjusted in renal issues?

Do the class 3 agents cause torsades and qt prolongation?

A

Amiodarone, Dofetilide, Dronedarone, Ibutilide, Sotalol

Yes

Yes

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7
Q

What is dofetilide’s black box warning?

What to know about oral amiodarone?

How do you dose amiodarone?

A

Must be monitored continuously for 3 days on EKG. Patients should be readmitted if dose is increased.

Slow and variable absorption, large volume of distribution, takes 2 days to 3 weeks to work, very long half life.

600-1200 mg daily for 1-2 weeks, decrease to 400-600 mg daily for 1-3 weeks, decrease to lowest maintenance dose possible(amiodarone 200 mg daily), dose adjustment with severe hepatic impairment.

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8
Q

What are the big amiodarone side effects to know?

What do you monitor on amiodarone?

What are the amiodarone drug interactions?

A

Corneal microdeposits and optic neuritis, GI upset, vomiting, constipation, blue gray skin discoloration, bradycardia/av block, hepatitis, hypotension, hypo and hyperthyroidism, insomnia, LFT abnormality, photosensitivity, pulmonary fibrosis, torsades, tremor/ataxia.

ECG(baseline, 6 months),LFT’s, TSH, T4(base line and 6 months for all of them),opthamolgic exam, physical, chest radiograph(baseline, yearly), history/physical.

Inhibitors/Inducers(Cyp 2c8,9, 2d6, and 3a4), QT prolongation, Beta-blockade, Warfarin, Statins(20 mg max dose on simvastatin)

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9
Q

What trials to focus on?

What did the DIONYSIS trial show?

What are the class 4 drugs? Side effects?

A

Jupiter, ACCORD, AIM High, PROVE IT( Lipids), ACCORD, ALL HAT, ACCOMPLISH(hypertension). DIONYSIS, AFFIRM(arrythmias).

More safety endpoints with amiodarone, dronedarone was less effective.

Nondihydropyridine CCB’s are Verapamil, Dilitiazem. Hypotension, sinus bradycardia, AV block, constipation.

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10
Q

What are the miscallenous antiarrtyhmics?

Which AA do we watch for use in Heart failure?

What do we watch for in SA or AV node dysfunction?

A

Adenosine, Digoxin, Magnesium(helps with torsaddes)

Disopyramide, Flecainide, Dronedarone

CCB’s, Beta blockers, Digoxin, amiodarone and dronedarone

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11
Q

What to avoid in WPW?

What to avoid in history of MI?

What about proloned QT interval? What to avoid in cardiac transplant?

A

Digoxin, CCB’s

Flecainide

Class 1a, 1c, and 3. Adenosine.

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12
Q

What to avoid in diarrhea? Prostatism and glaucoma?

Arthritis? Lung?

What to avoid in tremor?

A

Quinidine. Disopyrimide

Procainamide chronic. Amiodarone.

mexilitine

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13
Q

What are the non pharmacologic treatments of AF?

What drugs treat chemical cardioversion?

What drugs treat rate control?

A

Electrical cardioversion(>48 hours anticoagulation required for 3 weeks), Ablation, Atrial pacing and defibrillation.

flecainide, dofetilide, propafenone, ibutilide, amiodarone

beta blockers, CCB’s, digoxin

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14
Q

What drugs treat rhythm control?

What about antithrombotic therapy?

Do ACEI’s and ARBS help?

A

Class 1a, 1c, 3

CHA2DS2VASC

Can, decrease atrial pressure and reduce fibrosis in ACEI.

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15
Q

Can HMG CoA reductase inhibitors help?

What drugs can be used for chemical cardioversion?

Who should receive rhythm control?

A

Yes, still need additional mortality data.

Flecainaide, Dofetilide, Propafenone, Ibutilide, Amiodarone

Symptomatic HF(hypotension, worsening HF, MI), not permanent AFT, risk of antiarrhtymics

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16
Q

How to treat patients with hypertension and AF?

1st line for CAD?

1st line for HF?

A

If LVH–> Amiodarone and then catheter ablation. If none –>dronedarone, flecainide, propafenone, soletol

dofetilide, dronedarone, sotalol–> Amiodarone 2nd degree.

Amiodarone, Dofetilide

17
Q

Treat rhythym with patients that have minimal HD?

How to treat newly diagnosed AF?

How to treat recurrent paroxysmal AF?

A

Dronedarone, Flecainide, Propafenone, Sotalol

Paroxysmal–> no therapy unless symptomatic, anticoagulation PRN. Persistant–> Permanent af is rate control and anticoag.

minimal and no symptoms–> anticoag and rate control. Disabling symptoms–> anti coag and rate control–> antiarrythmic–>cardioversion

18
Q

What is the rule to remember for all AF?

What does CHA2DS2-VASc stand for?

How does the CHAD-VASc scoring work?

A

Rate control–> Rhythm control–> Ablation. Everyone needs anticoagulation if they qualify.

Congestive heart failure, hypertension, age>75(2 points), Previous stroke(2 points), vascular disease, age 65-74, sex female(65-74).

0–> no therapy needed. 1–> anti-platelet therapy. 2 or more–> warfarin, dabigatran, rivaroxaban, or apixaban.

19
Q

How to treat wide QRS and not symptomatic?

How to treat not symptomatic?

How to treat acute v tach?

A

Adenosine, Antiarrythmic IV–> Procainamide, Amiodarone, Sotalol.

Vaguel maneuvers 1st line–>Adenosine(2nd line)–> beta blockers.

Emergency–> Direct cardio version. Acute with milde symptoms–>Amiodarone, Procainamide and Lidocaine

20
Q

How to treat chronic v tach?

How to treat ventricular fibrillation?

What drugs can cause prolong QT?

A

Amiodarone

Direct cardio conversion.

Class 1a, 1c, 3.

21
Q

What to know about class 3 with qt prolongation?

What are antibiotics cause qt prolongation?

What neurologic agents cause qt prolongation?

A

Amiodarone has lowest risk of torsades, doefetilide is CI’d if baseline QTC is >440 ms or >500 ms if there is a ventricular conduction abnormality. Dronedarone CI’d if qts >500, Sotalol CI’d if qtc >450.

Macrolides(Azithromycin is the lowest risk of torsades), Fluoroquinolones–> Cipro is lowest risk, Moxi is the highest risk.

1st and 2nd generation anti psychotics, Antidepressants–> Citalopram(no more than 40 mg, older patients no more than 20), caution in patients with liver impairment. TCA’s, fluoxetine, paroxetine.

22
Q

How do you treat torsades?

How to treat chronic AV block?

How to treat 2nd or 3rd degree AV block?

A

First line is IV magnesium, isoproterenol, Class 2b antiarrythmics, transvenous overdrive pacing(temporary pacing)

Pace maker

Atropine, Epinephrine or dopamine

23
Q

What are the indications for primary prevention for ICD?

What about secondary prevention?

A

VT due to prior MI and inducible VT/VF at EPS

Survived VF and or sustatained VT not due to a reversible cause, strucural heart disease and sustained VT, unexplained suncope with VT or VF induced by EPS>

24
Q

What are the Indications for pacemaker?

The affirm trial confirmed what?

What antiarrhytmic treatmenet options are preferred for patients with atrial firbrillation and heart failure?

A

3rd degree AV block plus symptomatic, treatment with medication contributing to AV block, documented asystole, catheter ablation of AV junction, neuromuscular disease OR 2nd degree AV block that is symptomatic

Rate is better than rhythm control

Amiodarone and dofetilide

25
Q

AT’s past medical history includes AFIB, hypertension, diabetes, hypothyroidism. What is the CHADVASC score?

What options do you have for stroke prevention in afib?

What are medical conditions that can cause QT prolongation?

A

2(hypertension and diabetes)

Warfarin, DOAC’s, can use aspirin with CHADVASC score of 1.

Hypomagnesia, hypokalemia, hypothermia, starvation, heart failure, congential long qt syndrome

Assessment 2.5 (5 decks)

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