Rhythms and Stuff

Question 1

This Class I Antiarrhythmic has the greatest potency on its target and affects the myocyte action potential in this way

Answer 1

Class 1-C Antiarrhythmics

Flecainide

Question 2

Name the antiarrythmic that has this effect on the myocyte action potential.

Answer 2

Class IB Antiarrhythmic

Lidocaine

Question 3

Identify the Rhythm

Answer 3

Sinus Arrhythmia

Question 4

Identify the Rhythm

Answer 4

Junctional Rhythm

Question 5

28yr. Male

Hx of running 2 marathons per year; EKG was performed because of a health insurance requirement.

Based on the EKG, what is the next treatment?

Answer 5

No treatment; patient presented without an underlying disease in addition to being asymptomatic

2nd Degree Mobitz Type I (Wenkebach)

Question 6

Identify the Rhythm

Answer 6

Atrial Fibrillation

Question 7

Identify the Class I Antiarrhythmic agent that has this effect on the myocyte action potential

Answer 7

Class 1A Antiarrhythmics

Quinidine, Procainamide

Question 8

78yr. Male

HR: 48bpm

BP: 98/54

Shortness of Breath, Altered Mental Status

What are the immediate steps that must be done for this patient?

Answer 8

1. Start Atropine 0.5mg IV prior to pacing
2. Transcutaneous Pacing
3. Fluids if hypotension worsens
4. Consult Expertise

3rd Degree Heart Block (Complete Block)

Question 9

24yr. Female

Presents with cardiac palpitations, shortness of breath, and diaphoresis. Hx of well-controlled asthma. EKG was performed and revealed supraventricular tachycardia. She is unresponsive to vagal maneuvers.

What is the most likely treatment to convert the SVT back to Normal Sinus?

Answer 9

Class IV Antiarrhythmic – CCB

Diltiazem

Standard Protocol (not for asthmatics)

STEP 1: Vagal maneuver

STEP 2: Slam 6mg Adenosine

STEP 3: 12mg Adenosine, if still unconverted

STEP 4: Another 12mg Adenosine, if unconverted

STEP 5: Change Underwear, jk. IV Verapamil or Diltiazem
OK, asked Mrs. Butler and she would prescribe Cardizem (Diltiazem); however, the DOC for SVT is Adenosine in any other case.

Question 10

An Antiarrhythmic agent that has this effect on the myocyte action potential can be employed in which arrhythmias?

Answer 10

Class 1B Antiarrhythmic

Ventricular Arrhythmias (V-Tach, V-Fib)

Question 11

Identify the correct treatment for the arrhythmia

Answer 11

Class III Antiarrhythmic

Amiodarone

or

Class 1B Antiarrhythmic

Lidocaine

Question 12

32yr. Female

Complains of chronic fatigue and palpitations occurring more frequently throughout the past two weeks. She denies syncope.

Observe the EKG and determine a treatment

Answer 12

Start with low dose Beta-Blockers for HR control

If unresponsive or incapacitated by symptoms, SA Nodal Ablation

Inapproprate Sinus Tachycardia

Question 13

The most common cause for this type of rhythm

Answer 13

Reentry Pathway involving AV Node, Atrium, or Accessory Pathway

Question 14

57yr. Male

Complains of cardiac palpitations, feelings of diuresis, and dyspnea. Hx of Mitral Valve Replacement two years ago and is currently on warfarin. He denies any syncope and is unresponsive to vagal maneuvers.

Name the Rhythm.

Answer 14

Junctional Tachycardia

(Note the Inverted P waves)

Question 15

What is the name of the additional pathway between the atria and ventricles that causes the pre-excitation seen in this wave.

Answer 15

Bundle of Kent

Question 16