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Cardiology Med-Study > Lecture 10; Arrythmias > Flashcards

Lecture 10; Arrythmias Flashcards

1
Q

sawtooth pattern

A

atrial flutter

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2
Q

where does atrial flutter originate

A

cavo-tricuspid isthmus counterclockwise between IVC and tricuspid

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3
Q

treatment of atrial flutter

A

same as afib

  • rate and anticoagulation
  • most need to be ablated because they are hard to control with medicaitons
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4
Q

unstable atrial arrythmia tx

A

cardioversion

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5
Q

stable atrial arrhythmia

A
  • vagal/ AV manuevers

- BB, diltiazem

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6
Q

goal HR in atrial fibrillation

A

HR < 80 at rest

HR < 110 with exercize

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7
Q

Medications for rate control in afib

A

BB (proponalol, metoprolol, esmolol)
non-hydropyradime (diltiazem, verapamil)
digoxin
amioadorane

AV blockers (allow the conduction from the atrium to be conducted to the ventricle

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8
Q

Amiodarone toxicity

A

What A BITCH

B: bradycardia, Blue man sydnrome
I: interstitial lung disease, increased QTC
T: thyrdoid
C: - corneal micro
- cytochrome P450
- Increase Warfarin/Simvitastatin/digoxin levels - needs dose reduction
H: Hepatic, Hypotension

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9
Q

which rhythm control is used if structural heart disease

A

amiodarone

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10
Q

which rhythm control if no structural heart disease

A

flecanide
dofetilide
propafenone
ibutilide

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11
Q

lone a fib tx

A

nothing or ASA

CHADS2VASC 0-1

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12
Q

valvular afib tx

A

wafarin

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13
Q

tx non-valvular afib

A

CHA2DS2-VASc
Condition Points
C Congestive heart failure (or Left ventricular systolic dysfunction) 1
H Hypertension: blood pressure consistently above 140/90 mmHg (or treated hypertension on medication) 1
A2 Age ≥75 years 2
D Diabetes Mellitus 1
S2 Prior Stroke or TIA or thromboembolism 2
V Vascular disease (e.g. peripheral artery disease, myocardial infarction, aortic plaque) 1
A Age 65–74 years 1
Sc Sex category (i.e. female sex) 1

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14
Q

HAS BLED

A

> 3
caution
Condition Points
H Hypertension: (uncontrolled, >160 mmHg systolic) 1
A Abnormal renal function: Dialysis, transplant, Cr >2.26 mg/dL or >200 µmol/L ==> 1
Abnormal liver function: Cirrhosis or Bilirubin >2x Normal or AST/ALT/AP >3x Normal 1
S Stroke: Prior history of stroke 1
B Bleeding: Prior Major Bleeding or Predisposition to Bleeding 1
L Labile INR: (Unstable/high INR), Time in Therapeutic Range 65 years
1
D Prior Alcohol or Drug Usage History (≥ 8 drinks/week) == >1
Medication Usage Predisposing to Bleeding: (Antiplatelet agents, NSAIDs)
1

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15
Q

goal for INR afib

A

2-3

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16
Q

direct thrombin inhibitor

2 things to remember

A

digatraban

  • renally adjusted
  • no bridge needed
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17
Q

RAEF

A

rivoraxaban
Apixiban
Endoxaban
Factor XA inhibitors

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18
Q

which NOAC can be used in dialysis patients

A

apixiban - acting up kidneys

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19
Q

timing of anticoagulation around cardioversion

A

If cardioversion is planned, anticoagulation therapy is based on the duration of atrial fibrillation. For patients who are known to have been in atrial fibrillation for less than 48 hours, preprocedural anticoagulation is not necessary as the risk of thrombus formation is low. Patients with atrial fibrillation of unclear duration or those with atrial fibrillation for more than 48 hours require preprocedural anticoagulation. These patients should receive 3 weeks of therapeutic anticoagulation prior to cardioversion. Alternatively, transesophageal echocardiography (TEE) can be performed to look for an intracardiac thrombus. If TEE is negative for thrombus, acute cardioversion can be performed immediately

minimum of 4 weeks owing to an increased risk of thromboembolic events after restoration of sinus rhythm.

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20
Q

CAD + afib triple therapy management

A

if < 12 mo + stent ==> triple therapy
if < 12 mo, no stent = ASA + anticoagulation
if > 12 mo –> anticoagulation only

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21
Q

what are the contraindictations to ablation

A
  1. cannot be anticoagulated
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22
Q

wpw with afib

A

procainamide

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23
Q

best med post op afib

A

sotolal

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24
Q

when are PVC required to be treat

A

symtomatic/frequent (> 10,000 in 24 hours)

(>10% of all beat

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25
Q

tx symptomatic pvc

A

BB, NDP-C

26
Q

definition non=sustained v-tach vs. sustained

A

> 3 PVC sequential running at 100 bpm vs. no association + 30 seconds

27
Q

stable Vt tx

A

amio

28
Q

Pacemaker indications

A

Symptomatic bradycardia without reversible cause
Asymptomatic bradycardia with significant pauses (>3 seconds in sinus rhythm) or persistent heart rate <40/min
Atrial fibrillation with 5-second pauses
Asymptomatic complete heart block or Mobitz type 2 second-degree atrioventricular block
Alternating bundle branch block

29
Q

CRT

A

Patients with left ventricular ejection fraction (LVEF) of less than or equal to 35%, sinus rhythm, LBBB (left bundle branch block), New York Heart Association (NYHA) Class II, III or IV symptoms while on optimal medical therapy with a QRS duration of greater than or equal to 150 ms

30
Q

DOC Brugada

A

quinidine

31
Q

DOC SVT

A

Adenosine

32
Q

common 2/2 causes of bradycardia

A

elevated intracranial pressure, hypothyroidism, hyperkalemia, Lyme disease, and medication effects

33
Q

DOC HF and afib

A

digoxin

34
Q

AC despite CHADS

A

left atrial appendage thrombus, and hypertrophic cardiomyopathy require oral anticoagulation regardless of risk score

35
Q

NOAC reversal

A

The FDA recently approved idarucizumab, a monoclonal antibody that can be used in emergency situations to reverse the anticoagulant effects of dabigatran.

36
Q

pulmonary vein stenosis

A

Patients who develop dyspnea months to years after an atrial fibrillation ablation

37
Q

high likelihood of familial arrhythmia issue

A

The presence of unexplained premature (younger than 35 years) death or sudden death in a first-degree family member should raise suspicion for the possible presence of an inherited arrhythmia syndrome and referral to a cardiovascular specialist

38
Q

definition of long-QT syndrome

A

prolonged QTc interval (>440 msec in men and >460 msec in women) accompanied by unexplained syncope or ventricular arrhythmia

39
Q

tx long QT syndrome

A

irst-line therapy for long QT syndrome is β-blocker therapy. Patients with cardiac arrest or those who have recurrent events (syncope or VT) despite β-blocker therapy should undergo ICD implantation.

40
Q

definition and treatment of short QT syndrome

A

short QT interval, usually less than 340 msec (or QTc <350 msec).
high risk for SCD, and ICD placement is recommended for all patients.

41
Q

ACS for asystole PEA

A

asystole or pulseless electrical activity (PEA), CPR is continued with reassessment of rhythm status for a shockable rhythm every 2 minutes. Epinephrine (1 mg intravenously) should be given every 3 to 5 minutes, although vasopressin (40 units intravenously) can replace the first or second dose of epinephrine.

42
Q

ACS for VT/VF

A

In patients with VT/VF, a shock is advised with immediate resumption of CPR and reassessment of the rhythm in 2 minutes. Epinephrine should be given after the second shock and every 3 to 5 minutes thereafter. If VT/VF continues despite three shocks and epinephrine, amiodarone should be given as a bolus.

43
Q

bradycardia symptomatic tx

A

ymptomatic bradycardia and hemodynamic distress should first be treated with atropine. If atropine is ineffective, dopamine or epinephrine infusions can be attempted until transcutaneous pacing or a temporary pacing wire (preferred) can be implemented

44
Q

what should you not do in suspected device infecton

A

he device pocket should never be aspirated for diagnostic purposes because puncturing the pocket can damage the leads or introduce infection.

45
Q

QTC in female and man considered prolonged

A

450 in women and 470 in men

46
Q

treatment of congenital Long QT

A
  1. avoidance of Low MG/low K
  2. Antipsychotics/FQ/Anti-emetics/marcolides/antiarrythmics
  3. tx with BB
47
Q

Cheyne-stoke breathing

A

creascendo-decrescendo osillation in tidal volume and intervals of hyponea and apena

  • central sleep apnea
  • advanced Hf
48
Q

treatment atrial flutter

A

most effective and first line treatment is radiofrequency ablation

49
Q

treatment of pericarditis

A

NSAIDS and cholchine

NOT STEROIDS

50
Q

anticoagulation around cardioversion

A

3 weeks and then 4 weeks after

51
Q

triple DAPT and AC therapy

A

ACS < 12 months - triple

> 12 months - only AC

52
Q

when do you treat PVC with medication

A

BB

> 10,000 in 24 hours or > 10% of all beats are PVV

53
Q

pacemaker indications

A
  1. symptomatic bradycardia
  2. 2nd degree type 2 or third degree heart block
  3. sinus pauses > 3 seconds with afib
  4. alternating bifisciular block
54
Q

anticoagulation around surgery

A

low risk surgery - no interruption in warfarin without bridging
high risk surgery - temp interruption in wafarin

55
Q

who requires bridging

A

CHADS2VASC > 6

56
Q

QRS duration for BIV pacing

A

QRS > 150

57
Q

risk stratification for WPW

A

exercize stress test with increased HR or procainimide challenge.
Intermittent loss of delta waves is a good prognostic factor and don’t have to do anything else

58
Q

what medication need to be avoided in WPW

A

AV nodal blockers

59
Q

tx high risk WPW

A

catheter ablation

60
Q

INR goal mitral stenosis/afib

A

2.5

Cardiology Med-Study (9 decks)

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