Randoms

Question 1

Drugs for pharmacologic cardioversion

Answer 1

Amiodarone. Potassium channel blocker

Metoprolol. beta blocker.

Are often given prior to electrical cardioversion as well.

Adenosine, terminates AV-node dependent tachycardias, AVNRTs AVRTs, SNRTs, and focal AT

Amiodarone plus Lidocaine for V.Tach.

Question 2

Drug for ‘pill in the pocket’ A. fib treatment

Answer 2

Flecainide.

Sodium channel blocker.

Question 3

1st line drugs for Chronic A. fib

Answer 3

Beta blockers
or
Verapamil, Diltiazem
Ca++ channel blockers

Question 4

2nd line drugs for chronic a fib or paroxysmal a fib

Answer 4

Digoxin and Amiodarone.

Amiodarone - potassium channel blocker

Digoxin Na/K pump blocker, AV conduction suppressor, vagal tone increaser.

Question 5

Acute treatment for Torsades de pointes

Answer 5

Mg sulfate

Overdrive pacing.

Question 6

Relative contraindications for Electrical cardioversion

Answer 6

Digoxin toxicity - its usually refractory, treat with MGSO4 and digibind.

Reversible conditions causing the arrhythmia

Question 7

Arrhythmias that can be stopped with overdrive pacing

Rhythms that are not affected

Answer 7

AV junctional tachycardia
Paroxysmal reentry SVT

Atrial flutter
SVT with rapid ventricular response

V.Tach. — but may precipitate V.Fib.

Unaffected:
A.Fib
V.Fib
Sinus Tachycardia

Question 8

Common Pacemaker types (4) and their indications

Answer 8

AAI and DDD for the vast majority. Ventricle only pacing can cause A.Fib and Pacemaker syn.

AAI - Sinus bradycardia w/ good AV conduction

VVI - Persisten A. Fib

VDD - For AV blocks with normal sinus rhythm, synchronizing the chambers

DDD - Bradycardia and AV block

Question 9

Pacemaker letters

Answer 9

1st letter: Chambers paced
2nd letter: Chambers sensed
3rd letter: Response to sensing endocenous cardiac activity
4th letter: Rate modulation or not. Can it sense other physiologic parameters and appropriately increase/reduce pacing speed
5th letter: Multisite pacing. Does it pace at more than one location in the atria, ventricle, or multiple sites in both.

Question 10

Pacemaker lead placement

Answer 10

Ventricular leads: in the RV apex, or somewhere on the septum

Atrial: in the Right atrial appendage.

Question 11

Primary pericarditis causes

Answer 11

Primary pericarditis is uncommon

Viral causes: EBV, HIV, VZV, Coxsackie.
They are serous but reversible

Question 12

Secondary pericarditis causes

Answer 12

Uremia  acute fibrinous, can cause tamponade
Rheumatic fever  pancarditis, acute, fibrinous tamponade
Bacterial  fibrinopurulent
Tuberculosis  Caseous
Autoimmune  SLE, fibrinous
Malignancyg  hemorrhagic
Post-MI  fibrinous
Post surgical  fibrinous
Irradiation  fibrinous

Question 13

Pericarditis ECG signs

Answer 13

Are not extremely sensitive, and seen in <50% of patients.

1st stage/week:
Diffuse, Concave/Saddle ST elevation and PR depression in limb leads and precordial leads. Reciprocal PR elevation and ST depression in aVR

2nd stage 1-3 weeks. ST normalization, T wave flattening

Stage 3: several weeks: Flattened, Inverted T waves

Stage 4: ECG normalizes.

Question 14

Calculate Blood pressure from CO and TPR

Answer 14

BP = CO times TPR

Question 15

Location of the AV node

Answer 15

Lower back secion of the interatrial septum, near the opening of the coronary sinus.

Question 16

Location of the SA node

Answer 16

Upper part of the RA, near where the SVC joins the atrium.

Question 17

3 types of infective endocarditis

Answer 17

Native valve IE
Prosthetic valve IE
Drug associated IE

Question 18

Sprionolactone MoA and indications

Answer 18

Definitely for chronic heart failure,

A Potassium Sparing Diuretic, inhibits the aldosterone receptors.

Increases Na+ excretion while increasing postassium retention.