Day 7 Flashcards
The trade names of metoprolol are ____________.
Lopressor (metoprolol tartrate) and Toprol (metoprolol succinate)
Tenormin is ____________.
atenolol
Review the beta-blockers by selectivity.
- Metoprolol: ß1
- Atenolol: ß1
- Acebutalol: ß1 + intrinsic sympathomimetic activity (ISA)
- Nadolol: ß1 + ß2
- Propranolol: ß1 + ß2
- Timolol: ß1 + ß2
- Pindolol: ß1 + ß2 + ISA
- Carvedilol: ß1 + ß1 + a1
The utility of ISA in beta-blockers is that _____________.
it doesn’t decrease HR
CHADSVAS only applies to those with ____________.
non-valvular atrial fibrillation
What is the Watchman device?
A device deployed inside the atrial appendage that decreases stroke risk in atrial fibrillation (because most clots in the LA form in the atrial appendage).
What pathologies can lead to atrial fibrillation (meaning cellular patterns, not diseases)?
- Fibrosis
- Loss of muscle mass
- Dilation
The atrial rate of atrial flutter is _________.
The atrial rate of atrial fibrillation is _________.
250-300
300 - 600
List the disease states that cause a fib.
- HTN
- Atrial HTN
- Atrial ischemia
- Infiltrate
- Drugs
- TSH
- Mets
- Familial
- PE
- OSA
In acute atrial fibrillation, you need to first assess ____________.
ejection fraction
- In those with HFrEF, you cannot give nodal agents (ßB’s, CCB’s). Give amiodarone.
- In those with normal EF, you can give ßB’s.
If someone with atrial fibrillation does not respond to multiple medical agents –e.g., their rate is not controlled on propranolol and diltiazem, and their rhythm doesn’t respond to amiodarone –you can ____________.
ablate the AV node and implant a pacer
What are causes of pauses?
- 2ºAV block
- Non-conducted APC’s
- SA block
Review the DDx of narrow, regular tachycardia.
- AVRT
- AVNRT
- Sinus tachycardia
- Atrial flutter
- Ectopic atrial tachycardia
Review the DDx of narrow, irregular tachycardia.
- Atrial fibrillation
- Atrial flutter with variable block
- Multifocal atrial tachycardia
- EAT with variable block
Review the DDx of wide, regular tachycardia.
- Ventricular tachycardia
- SVT with aberrancy (BBB)
- Torsades (?)
Review the DDx of wide, irregular tachycardia.
- MAT with abberancy
- WPW with atrial fibrillation
- Atrial flutter with abberancy
- Ventricular fibrillation
P waves after QRS complexes in a narrow-complex, regular tachycardia is what rhythm?
AVRT
AVRT presents with the “late P waves”.
Adenosine does what to ectopic atrial tachycardia?
It converts it 70% of the time.
What is the criteria for an Ashman beat?
- Intermittent RBBB
- The R-R interval before the RBBB beat is longer than the R-R after the RBBB beat
- RBBB beats are usually singular but can be multiple
V-A association –meaning the P comes after the QRS complex –is a feature of which arrythmia?
AIVR
There is another type of AIVR in which the P waves march through.
Wide QRS, regular rhythm, rate 90, P’s coming after QRS =
AIVR
Deep T waves in V3 - V4 is typical of ___________.
apical HOCM
What rhythm is commonly seen in those on dopamine drips?
Accelerated junctional rhythm with occasional capture beats
- Usually rate of ~ 90 with irregular capture beats
- Narrow complex
iRBBB is seen in which type of congenital cardiac defect?
Secundum ASD
