Day 7

Question 1

The trade names of metoprolol are ____________.

Answer 1

Lopressor (metoprolol tartrate) and Toprol (metoprolol succinate)

Question 2

Tenormin is ____________.

Answer 2

atenolol

Question 3

Review the beta-blockers by selectivity.

Answer 3

• 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

Question 4

The utility of ISA in beta-blockers is that _____________.

Answer 4

it doesn’t decrease HR

Question 5

CHADSVAS only applies to those with ____________.

Answer 5

non-valvular atrial fibrillation

Question 6

What is the Watchman device?

Answer 6

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).

Question 7

What pathologies can lead to atrial fibrillation (meaning cellular patterns, not diseases)?

Answer 7

• Fibrosis
• Loss of muscle mass
• Dilation

Question 8

The atrial rate of atrial flutter is _________.

The atrial rate of atrial fibrillation is _________.

Answer 8

250-300

300 - 600

Question 9

List the disease states that cause a fib.

Answer 9

• HTN
• Atrial HTN
• Atrial ischemia
• Infiltrate
• Drugs
• TSH
• Mets
• Familial
• PE
• OSA

Question 10

In acute atrial fibrillation, you need to first assess ____________.

Answer 10

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.

Question 11

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 ____________.

Answer 11

ablate the AV node and implant a pacer

Question 12

What are causes of pauses?

Answer 12

• 2ºAV block
• Non-conducted APC’s
• SA block

Question 13

Review the DDx of narrow, regular tachycardia.

Answer 13

• AVRT
• AVNRT
• Sinus tachycardia
• Atrial flutter
• Ectopic atrial tachycardia

Question 14

Review the DDx of narrow, irregular tachycardia.

Answer 14

• Atrial fibrillation
• Atrial flutter with variable block
• Multifocal atrial tachycardia
• EAT with variable block

Question 15

Review the DDx of wide, regular tachycardia.

Answer 15

• Ventricular tachycardia
• SVT with aberrancy (BBB)
• Torsades (?)

Question 16

Review the DDx of wide, irregular tachycardia.

Answer 16

• MAT with abberancy
• WPW with atrial fibrillation
• Atrial flutter with abberancy
• Ventricular fibrillation

Question 17

P waves after QRS complexes in a narrow-complex, regular tachycardia is what rhythm?

Answer 17

AVRT

AVRT presents with the “late P waves”.

Question 18

Adenosine does what to ectopic atrial tachycardia?

Answer 18

It converts it 70% of the time.

Question 19

What is the criteria for an Ashman beat?

Answer 19

• 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

Question 20

V-A association –meaning the P comes after the QRS complex –is a feature of which arrythmia?

Answer 20

AIVR

There is another type of AIVR in which the P waves march through.

Question 21

Wide QRS, regular rhythm, rate 90, P’s coming after QRS =

Answer 21

AIVR

Question 22

Deep T waves in V3 - V4 is typical of ___________.

Answer 22

apical HOCM

Question 23

What rhythm is commonly seen in those on dopamine drips?

Answer 23

Accelerated junctional rhythm with occasional capture beats

• Usually rate of ~ 90 with irregular capture beats
• Narrow complex

Question 24

iRBBB is seen in which type of congenital cardiac defect?

Answer 24

Secundum ASD