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Cardiology > Week 3 > Flashcards

Week 3 Flashcards

1
Q

What is the main symptom a patient describes in PVC’s

What do they look like

A

Flip flop sensation in the heart

Wide QRS with no pwave, can be uni or multifocal

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2
Q

Paroxysmal atrial tachycardia

Rate:
Looks like:

A

Rate: 150-200

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3
Q

V-fib

What does it look like
rate:

A

-cardiac arrest

Rate: 350-450bpm

No true QRS and erractic multifocal rapid discharges

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4
Q

Torsades de points

-Rate:
what does it look like

-What is it associated with

A

Rate:250-350

sqirls around baseline, not even peaks

Associated with long QT syndrome, can turn into vfib

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5
Q

What do all supraventricular arrythmias have in comomom

A

They all have narrow QRS

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6
Q

Extopic Supraventricular Arrythmias:

main type: what does it look like

A

originate from ecoptic foca within the atria

Main type: Wandering atrial pacemaker:

irregularrly irregulary rhythm with atleast 3 pwave morphologies

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7
Q

Multifocal atrial tachycardia:

A

narrow QRS, 3 pwave morphologies plus tachycardia

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8
Q

Paroxysmal supraventricular tachycardia

Rate:
What does it look like:
Maneuver?

A

Rate: 150-250bpm
No p wave, narrow QRS
do valsalva maneuver and if it stops thats confirmatory

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9
Q

Paroxysmal atrial tachycardia

Rate:
What does it look like?

A

Rate: 150-250

P wave present and identical

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10
Q

Treatment for tacyarrythmias include what 5 things

A
  1. search for cause
  2. Treat with Ach protocol w/orw/out tyrosine/5htp/cofactors
  3. add SL B1, consider homeopathy
  4. Beta blocker, calcium channel blocker
  5. Anti-arrhthmic drugs
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11
Q

Botanicals for tachuarrythmia

A

Lycopus Virginicus (bugle Weed):

  • best when digitalis fails
  • Heart seditive mild vasoconstrictor

Leonarus Cardiaca (Motherwort)
More itises and CAD, PVC also
inhibits clot formation and relaxes hear cells, high in calcium

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12
Q

Treatment for PVC

A
  1. Reduce trigger
  2. Continue to exercise unless it worsens
  3. Add Ach protocol
  4. Treat B1 thaiamin deficiency
  5. Botanicals: crategus, leonarus, lycopus
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13
Q

A flutter
Rate:
What does it look like:
Treatment:

A

Rate: 220-300bpm

Looks like saw tooth p waves, narrow qrs, no st or pr interval

Treatment:

  1. rhythm control
  2. Rate control
  3. Anticoagulation
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14
Q

What can you do to control rate and rhythm for aflutter

A

Rhythm:

- Electrical cardioversion    - anti-arrhythmics   - cardiac ablation

Rate Control:

  • beta blcokers or ccb
  • Ach protocol
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15
Q

1st degree heart block looks like what?

A
  • PR interval >.20 sec (5small boxes)

- P before every QRS

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16
Q

Describe how you know there is a Morbitz Type I heart block

what is the other name for this

A

Wenkebach

  • Progressive lengthening of PR interval…
  • Randomly dropped QRS
  • QRS
17
Q

Describe what Morbitz type II looks like on an EKG

A
  • Pwave w/out QRS
  • PR may/may not be prolonged
  • Series of normal beats with equal normal Pr intervals
18
Q

Describe what a third degree heart block looks like on an EKG

A
  • P wave not associated with QRS

- P wave >0.20 sec

19
Q

What are the steps for treating Afib

A
  1. Firest detection order a 12 lead EKG to confirm
  2. If less than 48 hours do electroconversion
  3. Consider transesophageal echo
20
Q

How long do you have to be in afib before significant stroke risk

A

24-48 hours

21
Q

What are indications for urgent treatment of a fib (rate control or cardioversion)

A
  • Severe Symptoms
  • Hemodyanmically unstable
  • Evidence of pre-excitation
  • Evidence of ischemia or infart

SEND THEM TO THE HOSPITAL

22
Q

If less than 48 hours then do cardioversion, what are the 3 cercumstances for this

A
  • Active ischemia
  • Organ hypoperfusion/hemodynamically unstable
  • heart failure manifestations
23
Q

With A fib who do you consider hospitalization for?

A

New onset AF with:

  • ablation of accessory pathway
  • treatment of an emergent eitiolgy
  • tx of elderly due to high risk of thromboembolism
  • manage heart failure
  • initiation of anti-arrythmics
  • initiatio heparin
24
Q

If a fib has been greater then 48 hours what do you need to do?

How?

A

at least three weeks of anticoagulations beffore you can do any rhythm control or electrocardioversion

25
Q

In a hemodynamically stable person with afib how do you control their rhythm

A
  1. electrocardioversion
  2. chemical cardioversion
    • Amiodarone=most effected more SE
    • Digoxin: rarely converts out of AF
    • Class IC: more of a prophylactic
26
Q

In a hemodynamically stable person with afib how do you control their rate

A
  • Betablocker: metoprolol, atenolol
  • Calcium channelblocker: diltiazem, verapamil
  • digozin
  • amiodarone
27
Q

What are ND options for rate control

A
  • Ach protocol
  • corocalm
  • digitalis
  • B’s
  • lugols solution
  • magnesium
28
Q

In a hemodynamically stable person with afib how do you control anticoagulation

A

Calculate CHADS or CHA2DSVASc and HASBLED score to determine risk benefit

pharmaceuticals:
- Aspirin/clopidogrel
- Warfarin: narrow therapeutic window, increase risk for bleed

29
Q

ND first line alternatives to warfarin

A
  • Nattokinase
  • Fish Oil
  • Ginkgo
  • ASA
  • Grape Seed
  • Bromelain
  • Panax Ginseng
  • Vitamin E
  • Resveratrol
  • CoQ10
30
Q

How do you calculate CHADS2 Score and how many points is each worth

-what is it used for

A

Used to predict the risk of stroke in a fib patients

CHF:1

HTN: 1

AGE>75: 1

DM: 1

Stroke: 2

+left atrial apendage, atrial chamber enlargement

31
Q

What do scores 0-2 mean for CHADS2 score

A

0: no aspirin needed
1: Asprin 81-325 mg QD or Coumadin
2: Warfarin (INR2-3, Target 2.5)

32
Q

How do you calculate CHA2DS2 VASc Score and how many points is each worth

-what is it used for

A

Used to predict the risk of stroke in a fib patients

CHF: 1

HTN: 1

AGE >75: 2

DM: 1

Stroke/TIA: 2

Vascular(PAD, MI,Aorta Calcification):1

Age 65-74: 1

Sex Female: 1

33
Q

What do scores 0-2 mean for CHA2DS2 VASc score

A

0: No oral anticoagulation
1: Asprin 81-325 g QD or Coumadin
2: Warfarin

34
Q

How do you calculate HASBLED Score and how many points is each worth

what does it tell you

A

predicts risk of major bleed in afib patients
-all worth one point

HTN
Abn renal and/or liver function
Stroke
Bleeding prior
Labile InrS
Elderly>65
Drugs or Alcohol

> 3 anticoagulate with caution

Cardiology (8 decks)

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