Exam 1 - Treatments

Question 1

• Stable - Vagal Nerve Stimulation (Valsalva Maneuver or Carotid Massage)
• Unstable (*Very low/very high blood pressure) - Symptomatic, the patient failed vagal/carotid massage - Synchronized Cardioversion

Answer 1

Sinus Tachycardia

Question 2

Pacemaker (4)

Answer 2

Sinus Arrest

Idioventricular Rhythm

2nd Degree AV Block; Mobitz Type II

3rd Degree AV Block

Question 3

Atrial Pacing

Answer 3

Sinus Node Block

Question 4

No treatment is needed (Provide reassurance)

If persistent and/or symptomatic:

Beta-Blocker

Answer 4

Premature Atrial Contraction (PAC)

Question 5

No Treatment (8)

Answer 5

Sinus Arrhythmia

1st Degree AV Block

2nd Degree AV Block: Mobtiz Type I

Junctional Rhythm

Normal Sinus Rhythm

Wandering Pacemaker

Premature Atrial Contraction

Premature Junctional Contraction

Question 6

If symptomatic from 2nd Degree AV Block: Mobitz Type I from bradycardia, what intervention would you use?

Answer 6

Atropine

Question 7

There is no treatment for Accelerated Idioventricular Rhythm (AIVR). What should you do? How would manage symptoms?

Answer 7

Treat the underlying cause. Symptom management includes fluid resuscitation.

Question 8

What is an example of a condition that would cause AIVR?

Answer 8

Myocardia Infarction or Myocardial Ischemia

Question 9

• Acute Onset (< 24 hours)/Unstable: Cardioversion
• Chronic - Anticoagulation and Rate Control (B-Blocker, Ca2+ Channel Blocker), Aspirin, Watchman Device
• Refractory Cases or Definitive Treatment - Radio Frequency Ablation (RFA)

Answer 9

Atrial Fibriallation

Question 10

• Stable & Symptomatic: Antiarrhythmic
• Unstable, Symptomatic: Cardioversion

Answer 10

Atrial Flutter

Question 11

What happens if IVR is left untreated?

Answer 11

Asystole (Flatline)

Question 12

Symptomatic and Stable - Antiarrhythmic Drugs

Symptomatic and Unstable - Cardioverison (Consider overdrive pacing if recurrent).

Definitive Treatment - ICD (Implantable Cardioverter-Defibrillator)

Answer 12

Monomorphic Ventricular Tachycardia

Question 13

What is commonly associated with a healed infarction?

Answer 13

Monomorphic Ventricular Tachycardia

Question 14

• No effect from Carotid Massage
• Verapamil to slow conduction.

Answer 14

Multifocal Atrial Tachycardia (MAT)

Question 15

• Carotid massage has little/no effect.
• Stable - Adenosine, Ca2+ blocker, Beta-Blocker
• Unstable - Cardioversion

Answer 15

Paroxysmal Atrial Tachycardia (PAT)

Question 16

• Stable/Symptomatic - Typically responds (slows or terminates to carotid massage/vagal maneuvers)
• Pharmacologic agents if unsuccessful: IV Adenosine first or Verapamil Second
• Unstable/Symptomatic - Cardioversion

Answer 16

Paroxysmally Supraventricular Tachycardia

Question 17

Assess for the presence of a pulse.

Pulse - Beta-Blockers, or Temporary Pacing while addressing the underlying cause.

No Pulse - Defibrillation and CPR.

Note: Avoid antiarrhythmic, may prolong QT interval.

Answer 17

Polymorphic Ventricular Tachycardia

Question 18

Symptomatic - Address the underlying cause.

Beta-Blockers may provide symptomatic relief.

Answer 18

Premature Ventricular Contraction

Question 19

Symptomatic:
- Fatigue, hypotension

The goal of Treatment:
- Increase HR

Pharmacologically:
- Atropine

Consider using a temporary transcutaneous pacemaker (if the underlying cause indicates).

Answer 19

Sinus Bradycardia

Question 20

CPR and Defibrillation

Follow ACLS protocols for Ventricular Fibrillation

Answer 20

Polymorphic Ventricular Tachycardia

Question 21

What is required long-term with survival from Ventricular Tachycardia?

Answer 21

ICD = Implantable Cardioverter-Defibrillator