Therapeutics

Question 1

What should you give/not give in acute heart failure?

Answer 1

diruretics (Lasix)

DONT give beta blockers

continue anti-hypertensive and anti-thrombotics

looking for 1-2 liters net negative

telemetry (prone to A fib)

Question 2

What are the guidelines for ICD placement in heart failure?

Answer 2

Ischemic Cardiomyopathy

NYHA Class II or grater symptoms

EF less than 35% post-MI after 40 days

Non-ischemic cardiomyopathy

Same as avoe, but give it 90 days post-MI

Question 3

What is diastolic heart failure?

Answer 3

heart isn’t filling completely - ejection fraction is preserved

Question 4

What is systolic heart failure?

Answer 4

heart is filling properly, LV to weak to push it all out during systole, EF reduced

Question 5

What is the therpay for diastolic heart failure?

Answer 5

management of BP

diabetes

other comorbidities

Question 6

what is the management of systolic heart failure?

Answer 6

beta blocker - metoprolol

ACE-IARB

Aldosterone Antagonist

Question 7

What is paroxysmal A Fib

Answer 7

lasting less than seven days

Question 8

Why is stroke risk increased in A fib?

Answer 8

blood flow slows in atrium - accumulates in atrial appendage and can clot and go anywhere

Question 9

What are the CHADS- VASc criteria?

Answer 9

Used to determine who in A Fib needs coagulation

Question 10

What are the CHADS-VASc criteria and scores?

0 = low

1 = moderate

>1 = high

Answer 10

CHF (or LVEF <40)- 1

Hypertension - 1

Age >75 - 2

DM - 1

Stroke (or TIA or thromboembolism) - 2

Vascular disease - 1

Age 65-74 - 1

Female -1

Question 11

When do you favor rate control in Afib?

Answer 11

Persistent

less symptoms

Age > 65

previous failure of antiarrythmic

(try to keep rate <110)

Question 12

What are the ventricular rate control choices for Afib?

Answer 12

vagal

cardioversion (if unknown duration or >48 hours TEE)

unless you have been on constant anticoagulation

drug cardioversion with Calcium channel blockers

Question 13

What is a rhythm control agent for Afib?

Answer 13

amiodorone

prolongs QT - watch out!

Question 14

What’s the problem with Plavix (clopidogrel)?

Answer 14

It’s a great anti-platelet drug by 20% of the population are non-responders

Question 15

What do you use to treat SVT?

Answer 15

Vagal first

If that fails, push 6mg adenosine

then 12 mg adenosine

Question 16

What do you do for sinus tach?

Answer 16

treat the underlying cause

usually pain!

Question 17

Why is Afib such a huge problem for people with WPW and antidromic AVRT?

Answer 17

There’s no brake on ventricular rate now - go into V fib

Question 18

What do you do for A flutter?

Answer 18

Treat it like A Fib

Question 19

What if you use adenosine on SVT and you don’t convert?

Answer 19

synchronized cardioversion

Question 20

What can you do long term for people with recurrent SVT?

Answer 20

Ablate the focus (98% cure rate)