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16 Cards in this Set

  • Front
  • Back
Which of these is NOT a Class I anti-arrhythmic?
a.) diltiazem
b.) lidocaine
c.) flecainide
d.) procainamide
(Bonus: What channel do Class I meds block?)
a.) diltiazem (Ca channel blocker)

Class I meds are Na channel blockers
Which of these anti-arrhythmic medications is the most appropriate first line choice for an acute ventricular tachycardia in a stable patient?
a.) flecainide
b.) lidocaine
c.) propanolol
d.) verapamil
b.) lidocine, fast acting Na channel blocker (class Ib)

Can also use amiodarone, a K channel blocker used

You can also use procainamide if amiodarone is not available, but don't use both because you can create long QT
Which of these anti-arrhythmic medications is the most appropriate first line choice for an acute supra-ventricular tachycardia in a stable patient?
a.) flecainide
b.) amiodarone
c.) propanolol
d.) verapamil
e.) adenosine
e.) adenosine

If adenosinex2 does not work, you can follow with amiodarone or procainamide.

For stable patients, prior to administering meds, should try vagal maneuvers (ice on face for baby; valsalva for older kids)
Which of these should NOT be given to a kid with WPW in SVT?
a.) procainamide
b.) adenosine
c.) verapamil
c.) verapamil - this Ca channel blocker blocks the AV node and can lead to V-tach/V-fib in these kids.

You should use caution with adenosine for similar reasons. Procainamide (Na channel blocker) is the drug of choice.
What are EKG findings of premature atrial complexes?
-early/weird morphology P waves [this is because PAC P waves have an ectopic origin and don't come from the sinus node]
-Pause after QRS before the next sinus P wave
-QRS complex should be normal
Define the following terminologies for PVCs (premature ventricular complexes):
- couplet
- bigeminy
- trigeminy
- couplet = 2 successive PVCs
- bigeminy = sinus beat followed by PVC
- trigeminy = sinus beat followed by 2 PVCs
Atrial fibrillation is uncommon in children. What are some causes/associations of a-fib in kids?
1. congenital heart disease
2. cardiomyopathy
3. WPW
4. some adolescent patients can develop it after SVT - "tachycardia induced tachycardia"
5. some [health] kids get it after hypervagal event (drinking cold water)
6. rare familial disorders
What are some causes/associations of atrial flutter in kids?
1. neonates with Coxsackie myocarditis & maternal lithium treatment cases reported
2. older kids - primarily seen post cardiac surgery (Fontan)
Ventricular premature beats are relatively common and usually benign. What is the work-up for these kids?
24 hour Holter or exercise testing.

As the heart rate increases, benign ventricular premature beats usually disappear (the sinus tachycardia overrides the PVC). If exercise results in an increase or coupling of contractions, underlying disease may be present.
What is the accessory pathway in WPW called?
Bundle of Kent - abnormal pathway between atrium and ventricle
What is the difference between an automatic tachycardia and a reentrant tachycardia?
automatic
-20% of kiddy arrhythmias
-from a focus of cardiac tissue developing fast depolarization
-usually under autonomic control
-can be paroxysmal or incessant - incessant can lead to DCM

reentrant
-80%
- involve two atrioventricular connections where electrical conduction travels down one of the pathways and then backs up the other, creating a sustained repetitive circular loop
-start/stop abruptly
What medication given during SVT transiently blocks AV conduction and terminates tachycardias that incorporate the AV node or may aid in the diagnosis of arrhythmias confined to the atrium by causing a pause in ventricular conduction, so one can identify the presence of multiple P waves?
adenosine
Neonate with complete heart block. You think...
Maternal lupus!
Teenager with syncope. What are warning signs from the history to do further work-up?
-occurred during exercise
-or with stress
-or is associated with a positive family history
What meds can convert VFib?
Drugs CAN'T by themselves!

Defibrillation is the KEY.
How does amiodarone function?
K channel blocker - increasing repolarization & refractory periods