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GEN MED II Final EXAM > Study for Gen Med II Final Part @ > Flashcards

Study for Gen Med II Final Part @ Flashcards

1
Q

SVT

A

Impulses initiate from above the ventricles, anywhere really but we usually mean the SA node.

Over 160 bpm

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2
Q

SVT

A

Super Fast Impulses initiate from above the ventricles, anywhere really but we usually mean the SA node.

Over 160 bpm
Very Regular
Skinny QRS

If they come from anywhere other than the SA node, the p waves will have different shapes and we call that Multi Focal Tachycardia - it is an SVT but when we say SVT we mean either

ReEntry Tachycardia

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3
Q

SVT

A

Super Fast Impulses initiate from above the ventricles, anywhere really but we usually mean the SA node.

Over 160 bpm
Very Regular
Skinny QRS

If they come from anywhere other than the SA node, the p waves will have different shapes and we call that Multi Focal Tachycardia - it is an SVT but when we say SVT we mean either

ReEntry Tachycardia or AV Nodal ReEntry Tach
or

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4
Q

Most Common Cause of Palpitations in people with normal hearts

A

SVT: AV Nodal ReEntry Tachycardia

Fast/SLow Reentry

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5
Q

SVT

A

Super Fast Impulses initiate from above the ventricles, anywhere really but we usually mean the SA node.

Over 160 bpm
Very Regular
Skinny QRS

If they come from anywhere other than the SA node, the p waves will have different shapes and we call that Multi Focal Tachycardia - it is an SVT but when we say SVT we mean either

ReEntry Tachycardia or AV Nodal ReEntry Tach
Short PR with a delta wave slur as R rises from Q.

Wolf Parkinson White - Here SA impulses travel both through the AV Node but the Right Purkinje and also via the Bundle of Kent on the Right side of the heart.

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6
Q

SVT

A

Super Fast Impulses initiate from above the ventricles, anywhere really but we usually mean the SA node.

Over 160 bpm
Very Regular
Skinny QRS

If they come from anywhere other than the SA node, the p waves will have different shapes and we call that Multi Focal Tachycardia - it is an SVT but when we say SVT we mean either

ReEntry Tachycardia or AV Nodal ReEntry Tach
Short PR with a delta wave slur as R rises from Q.

Wolf Parkinson White - Here SA impulses travel both through the AV Node but the Right Purkinje fibers extend almost back to the Atrium and there is an open bundle of neuroconductive tissue there that conducts the impulse from the end of the Purkinjes BACK into the Atrium. These impulses go in through the AV and out through the Bundle of Kent and then BACK down the AV node, hopelessly circling.

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7
Q

Rate is 140 -250

Delta wave “slurs” beginning of QRS

A

Wolf Parkinson White

Cardiovert or

Use Adenosine or Verapamil IV (try Adenosine 1st

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8
Q

Rate is 140 -250

Delta wave “slurs” beginning of QRS

A

Wolf Parkinson White

Cardiovert or

Use Adenosine or Verapamil IV (try Adenosine 1st

Definitive Treatment is Ablation of the Bundle of Kent so it’s unavailable.

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9
Q

Metallic Taste & Feeling of “Impending Doom”

A

Adenosine Side Effects

Used for WPW SVT

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10
Q

SVT

A

Super Fast Impulses initiate from above the ventricles, anywhere really but we usually mean the SA node.

Over 160 bpm
Very Regular
Skinny QRS

If they come from anywhere other than the SA node, the p waves will have different shapes and we call that Multi Focal Tachycardia - it is an SVT but when we say SVT we mean either

ReEntry Tachycardia or AV Nodal ReEntry Tach
There are 2 paths through the AV Node: Fast & Slow. Fast goes direct to the ventricle and if Slow gets to the common ventricular path just after Fast goes through, it is shunted backwards up the fast path back into the atrium where it elicits another impulse.

Wolf Parkinson White - Here SA impulses travel both through the AV Node but the Right Purkinje fibers extend almost back to the Atrium and there is an open bundle of neuroconductive tissue there that conducts the impulse from the end of the Purkinjes BACK into the Atrium. These impulses go in through the AV and out through the Bundle of Kent and then BACK down the AV node, hopelessly circling.

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11
Q

Looks like super fast narrow QRSs separated by what look like notched T waves (but aren’t)

A

ReEntry SVT

Use Vagal Maneuvers/Unilateral Vagal Massage

Adenosine 6 mg IV Fast Push
If no Response in 1-2 min, double it
12 mg IV Fast Push
If no Response Cardiovert

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12
Q

Adenosine 6 mg IV Fast Push
If no Response in 1-2 min, double it
12 mg IV Fast Push
If no Response Cardiovert

A

Rx for SVT

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13
Q

DON’T USE DIGOXIN WITH

A

Wolf Parkinson White EVER

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14
Q

Looks like super fast narrow QRSs separated by what look like notched T waves (but aren’t)

Condition & Rx?

A

ReEntry & WPW SVT

Use Vagal Maneuvers/Unilateral Vagal Massage

Adenosine 6 mg IV Fast Push
If no Response in 1-2 min, double it
12 mg IV Fast Push
If no Response Cardiovert

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15
Q

Atrial Flutter Rx

A

Acute: Cardiovert. Anticoagulate w/Heparin if Flutter began more than 48 hours ago. No need if not 48 hrs into the rate.

To Manage: Amiodarone #1
or DoFetilide

Ablate if there is reentry to cure

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16
Q

AFIB Rx

A

If more than 48 hrs into the rhythm and you can do it, TEE to see if there are clots in the Rt Atrium.

If there are clots, anti coagulate for FOUR WEEKS, then cardiovert

If no clots cardiovert immediately

Either way, start Warfarin

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17
Q

AFIB Rx

A

If more than 48 hrs into the rhythm and you can do it, TEE to see if there are clots in the Rt Atrium.

If there are clots, anti coagulate for FOUR WEEKS, then cardiovert

If no clots cardiovert immediately

Either way, start Warfarin

For Rate Control, Use Amiodarone or DIG
Frankly, both are pretty dangerous but your Pt will need to come in for regular PT-INR checks on the warfarin so keep a good eye on your Dig levels - don’t know if one gets Amiodarone levels - watch for pulmonary fibrosis with Amiodarone.

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18
Q

40-60 bpm, regular but no p waves

A

Junctional

Junctional Tachycardia is over 100, regular and has no p-waves . Technically, its an SVT
It’s associated with DIG Toxicity and Heart Failure.

Accelerated Junctional Rhythm is 60-100, no p waves

J-Tach is different from ReEntry SVTs in that it’s totally flat between QRS complexes, no “notched T” look.

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19
Q

PR interval is constant but over 0.12 sec

A

1st Degree Heart Block

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20
Q

PR interval is Going Going and then a QRS is GONE

A

2nd Degree Winkibach/Movitz I

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21
Q

PR interval is Going Going and then a QRS is GONE, the p wave failed to get thru the AV node to the ventricles and we lost a QRS

A

2nd Degree Winkibach/Movitz I

Due to Bradycardia. It Pt is on a beta blocker, reduce the dose.

If not caused by meds, consider pacemaker

22
Q

PR is constant and there’s just a missing QRS

A

2nd Degree Heart Block, Movitz II

Frequently progresses to 3rd degree
Prepare for Pacemaker

23
Q

Ps march out completely unrelated to the QRSs

A

3rd Degree Total Heart Block

24
Q

Ps march out completely unrelated to the QRSs

A

3rd Degree Total Heart Block

Pacemaker Needed AV Node impassable

25
Q

Sick Sinus Syndrome

A

SA node is wacky:

Too Slow
Too Fast
Fast then Slow Then Fast

Hard to catch on an EKG, Pt needs to wear a Holter Monitor around for days to see what’s going on

26
Q

Sick Sinus Syndrome

A

SA node is wacky:

Too Slow
Too Fast
Fast then Slow Then Fast (Brady Tachy Synd)

Hard to catch on an EKG, Pt needs to wear a Holter Monitor around for days to see what’s going on

27
Q

Sick Sinus Syndrome

A

SA node is wacky:

Too Slow
Too Fast
Fast then Slow Then Fast (Brady Tachy Synd)

Hard to catch on an EKG, Pt needs to wear a Holter Monitor around for days to see what’s going on.

This needs a pacemaker once you nail it.

28
Q

Bundle Branch Block

A

There is a block in the bundle branch between HIS and the purkinkes. An alternate path forms in order to depolarize the ventricles. The alternate path takes longer so the unaffected ventricle contracts first then the affected ventricle goes.

This results in a very wide QRS, likely with two R peaks (R & R-Prime)

In Right BBB - the right ventricle depolarizes late and you see the Bunny ears in the right leads: V1 & V2

In Left BBB, the left one is late and you see bunny ears in I, aVL, V5 and/or V6. These might just be wide QRS (over .12) or there may be slurred Rs or actual bunny ears

Left is suggestive of greater cardiac damage with a higher mortality rate

Right is associated with Cor Pulmonale

29
Q

Bundle Branch Block

A

There is a block in the bundle branch between HIS and the purkinkes. An alternate path forms in order to depolarize the ventricles. The alternate path takes longer so the unaffected ventricle contracts first then the affected ventricle goes.

This results in a very wide QRS, likely with two R peaks (R & R-Prime)

In Right BBB - the right ventricle depolarizes late and you see the Bunny ears in the right leads: V1 & V2

In Left BBB, the left one is late and you see bunny ears in I, aVL, V5 and/or V6. These might just be wide QRS (over .12) or there may be slurred Rs , notched Rs or actual bunny ears

Left is suggestive of greater cardiac damage with a higher mortality rate

Right is associated with Cor Pulmonale

30
Q

VTACH is a ventricular driven Tachycardia with no SA node involvement

A

It is Lethal

It is a sinus-y wave on EKG and BIG

31
Q

VTACH is a ventricular driven Tachycardia with no SA node involvement

A

It is Lethal

It usually starts as PVCs 3PVC=VTACH

32
Q

VTACH is a ventricular driven Tachycardia with no SA node involvement

A

It is Lethal
It usually starts as PVCs 3PVC=VTACH
if a PVC lands on a T wave, VTACH may result.

VTACH gets cardioverted

33
Q

PVC

A

Premature Ventricular Tachycardia

ectopic Ventricular pacemakers set off a contraction.

PVCs from different ventricular pacemakers look different, you can count the ectopics involved this way

3 PVC = VTACH

34
Q

VTACH is a ventricular driven Tachycardia with no SA node involvement

Monomorphic - one shape to the huge QRSs.
Monomorphics do look different in the different leads but within a lead, they’ll look alike

Polymorphic - more than one pacemaker tossing these contractions off, more than one QRS shape Torsades Des Points

There can be polymorphous all from the same pacemaker, they don’t look like Torsades but aren’t monomorphic either

A

100-250 bpm
Likely to proceed to VFib & quickly if it doesn’t self resolve in 30 sec (non sustained VT)

It usually starts as PVCs 3PVC=VTACH
if a PVC lands on a T wave, VTACH may result.

VTACH gets cardioverted

35
Q

PVC

A

Premature Ventricular Tachycardia

ectopic Ventricular pacemakers set off a contraction.

PVCs from different ventricular pacemakers look different, you can count the ectopics involved this way

3 PVCs IN A ROW = VTACH
Bigeminy = PVC every other normal QRS
Trigem (every third QRS) & Quadrageminy too

36
Q

VTACH is a ventricular driven Tachycardia with no SA node involvement

Monomorphic - one shape to the huge QRSs.
Monomorphics do look different in the different leads but within a lead, they’ll look alike

Polymorphic - more than one pacemaker tossing these contractions off, more than one QRS shape Torsades Des Points

There can be polymorphous all from the same pacemaker, they don’t look like Torsades but aren’t monomorphic either

Bidirectional VTach: Dig Toxicity
QRSs go both up and down within the same lead.

A

100-250 bpm
Likely to proceed to VFib & quickly if it doesn’t self resolve in 30 sec (non sustained VT)

It usually starts as PVCs 3PVC=VTACH
if a PVC lands on a T wave, VTACH may result.

VTACH gets cardioverted

37
Q

Medication causes of Torsades

A

Drugs that lengthen QT interval:

Procainamide/Quinidine
Tricyclics (why we don’t use them much now)
Haloperidol
ERYTHROMYCIN
KETOCONIZOLE
Compazine & Thorazine (antipsychotic)
Phenergan (antiemetic- why we now use Zofran)

AND

HypOMagnesium - give MgSulfate to Torsades always. If K+ is low, give MgSO4 just in case as Mg & K run together.

38
Q

VTACH Rx

A

If unstable (SOB or Hypoxic)
Cardiovert ASAP
100-360 Joules

If Pt is tolerating the rhythm w/o SOB/Hypoxia
Give Lidocaine 1mg/Kg IV Bolus
or
Amiodarone 150mg SLOW bolus over 10 min then 1mg/minute over 6 hrs. This med will save the pt today but they’ll likely die in 6 mo - its a trade off. Try Lidocaine and Cardioversion first.

39
Q

VTACH Rx

A

If unstable (SOB or Hypoxic)
Cardiovert ASAP
100-360 Joules

If Pt is tolerating the rhythm w/o SOB/Hypoxia
Give Lidocaine 1mg/Kg IV Bolus
or
Amiodarone 150mg SLOW bolus over 10 min then 1mg/minute over 6 hrs. This med will save the pt today but they’ll likely die in 6 mo - its a trade off. Try Lidocaine and Cardioversion first.

For maintenance: Amiodarone + BBlocker

Implant a defibrillator

40
Q

VTACH is a ventricular driven Tachycardia with no SA node involvement

Monomorphic - one shape to the huge QRSs.
Monomorphics do look different in the different leads but within a lead, they’ll look alike

Polymorphic - more than one pacemaker tossing these contractions off, more than one QRS shape Torsades Des Points

There can be polymorphous all from the same pacemaker, they don’t look like Torsades but aren’t monomorphic either

Bidirectional VTach: Dig Toxicity
QRSs go both up and down within the same lead.

A

100-250 bpm but pretty REGULAR

Likely to proceed to VFib (IRREGULAR) & quickly if it doesn’t self resolve in 30 sec (non sustained VT)

It usually starts as PVCs 3PVC=VTACH
if a PVC lands on a T wave, VTACH may result.

VTACH gets cardioverted

41
Q

VFIB

A

IRREGULAR VENTRICULAR Tach 300-600bpm

Multiple Foci w/Wandering Baseline

No effective contraction so no blood is moving out of the heart - we have minutes only here!

42
Q

The “H6T5” of VFib Causes:

A 
Hypovolemia
Hypoxia
Hydrogen Ions (acidosis)
Hyper K+
Hypo Glycemia
Hypo Thermia

Toxin (dig? order drug levels)
Tamponade (get ECHO)
Tension Pneumothorax (Trachea midline? CXR)
Thrombosis blocking Coronary Artery? (TPA)
Trauma (back to hypovolemia & Tamponade)

43
Q

VFIB

Coarse VFiB is big
Fine VFIB is small

A

IRREGULAR VENTRICULAR Tach 300-600bpm

Multiple Foci w/Wandering Baseline

No effective contraction so no blood is moving out of the heart - we have minutes only here!

DEFIBRILLATE ASAP!!! 200-300 JOULES
DO IT 3X, ADDING JOULES EACH TIME THEN
Add drugs:  Lidocaine or Amiodarone
Add: Epi for BP
Add MgSO4 incase it's was a torsades vtach

If you save this guy, figure out what caused it
MI? Drugs?

44
Q

Most common cause of Cardiac Sudden Death in young Asian men under 30

A

Brugada Syndrome

RBBB

45
Q

Right Ventricular Hypertrophy on EKG

A

R wave greater than S wave in V1

46
Q

Right Ventricular Hypertrophy on EKG

A

R wave greater than S wave in V1
S wave greater than R wave in V6

recall left venter. hypertrophy is the R wave in V1 + Swave in V5 greater than 35

47
Q

rate controller that can cause 1st degree block

A

BBlocker
CCBlockers
Dig

48
Q

Prinzmetal’s Angina is caused by vasospasm

A

Angina at rest in cycles

Rx is Nifedipine

49
Q

SVT medication

A

Adenosine 6mg Fast Push followed by Diltiazem if you break the rhythm

50
Q

Don’t Use Metropolol for

A

SVT

GEN MED II Final EXAM (2 decks)

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