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Cardio Final > Treatment of Ventricular Arrhythmias > Flashcards

Treatment of Ventricular Arrhythmias Flashcards

1
Q

Drug classes used in ventricular arrhythmias

A 
Class 1b antiarrhythmics
Class 3 amiodarone and sotalol online
BB (management and prevention)
Vasoconstrictors (epinephrine and vasopressin) - complete CV collapse
DCC
ICD
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2
Q

Define ICD

A

Implantable Cardioverter Defibrillator
Device implanted in the patient that monitors dangerous ventricular rhythms and delivers electrical shocks to reset the heart rhythm
- only for high risk pts

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3
Q

Define Premature Ventricular Contractions (PVC)

A

Early depolarization of the ventricles

Not dangerous unless repeated frequently

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4
Q

Management of PVC

A

Aysymptomatic: none

Symptomatic (palpitations or syncope) –> beta blocker

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5
Q

Tosades de pointes =

A

Polymorphic Ventricular Tachycardia

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6
Q

Define Polymorphic Ventricular Tachycardia

A

A unique type of ventricular tachycardia that increases in frequency with prolong QTc interval

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7
Q

Management of Polymorphic VT or Torsades

A

ID and d/c drug-related causes
Correct electrolyte abnormalities (K.4 or Mg >2.2)
Mg 1-2 g IV bolus (repeat PRN up to 16g/24hrs)

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8
Q

Define Ventricular Tachycardia

A

Multiple (3+) premature ventricular contraction with tachycardia (HR > 100)

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9
Q

Define Monomorphic

A

All the beats are the same (equal QRS on EKG)

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10
Q

Define Non-sustained VT:

A

Lasting less than 30 seconds

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11
Q

Symptomatic nSVT

A

Palpitations, uncomfortable beats or syncope

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12
Q

Structural Heart Disease nSVT

A

“Structural heart disease for our purposes would be those with left ventricular hypertrophy, heart failure, or ischemic heart disease (acute or chronic).”

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13
Q

Define Sustained VT

A

Lasting more than 30 seconds

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14
Q

Stable SVT

A

Hemodynamically stable with BP and HR within normal range

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15
Q

Unstable SVT

A

Hemodynamically unstable, BP and HR outside of normal range

May include changes in metnation, lack of pulse

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16
Q

Define Ventricular Fibrillation

A

Cause of sudden cardiac deaht, electrical anarchy of the ventricle with cardiovascular collapse

17
Q

Lidocaine Class? AE?

A 
1b
Hypotension
Bradycardia
NYSTAGMUS
Dizziness
 Confusion
Seizures
18
Q

Lidocaine Notes

A

Requires drug monitoring

19
Q

Amiodarone Class? AE?

A 
3
Bradycardia
Heart Block
Hypotension
Pulmonary toxicity
Hypo/hyperthyroidism
Corneal deposits
Skin discoloration
QT prolongations
20
Q

Nystagmus and dizzines are early signs of

A

toxicity for lidocaine

21
Q

Amiodarone Notes

A

MD is higher than for AF and this increases risk for side effects and toxicity

22
Q

Amiodarone Monitoring Chronic Therapy

A

CXR and pulmonary function tests at baseline and with symptoms
Thyroid panel at baseline x 6 months
LFT at baseline x 6 months
Eye exam at baseline x 12 months

23
Q

Vtac (monomorphic) and Vfib first things to do

A

Correct underlying cause
Remove arrhythmogenic drugs
Replace K > 4 and Mg > 2.2

24
Q

nSVT Asymptomatic Treatment

A

No SHD: No therapy

Yes SHD: BB or amiodarone

25
Q

nSVT Symptomatic Treatment

A

No SHD: BB

Yes SHD: treat like stable SVT

26
Q

Stable SVT Treatment

A

Amiodarone IV then PO (maybe lidocaine)

27
Q

Unstable/Pulseless SVT Treatment

A

Treat like VF

28
Q

VF Treatment (don’t need to focus much on this)

A

CPFI and Defibrillate PRN
Epinephrine IV OR Vasopressin IV
Consider: Amiodarone 300 mg IV x 1 then 150 mg x 1 OR lidocaine 1.5 mg/kg x1 then 0.75 mg/kg x2

29
Q

**Common Medications that prolong QTc

A 
Class 1a anti-arrhythmics
Class 3 anti-arrhythmics
Macrolides
Quinolone
Antipsychotics
Methadone
Ranolazine
30
Q

** Additional RF that prolong QTc

A 
HypoK
HypoMg
HypoCa
>480 msec QTc
HF or Acute MI
Bradycardia
Genetic predisposition

Cardio Final (12 decks)

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