Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
71 Cards in this Set
- Front
- Back
|
What are 5 common symptoms of cardiac arrhythmias?
|
1. Syncope/Presyncope
2. Palpitations 3. Dizziness 4. Chest pain 5. Symptoms of CHF |
|
|
When should you NOT perform carotid massage to slow ventricular rate (to determine rhythm)?
|
When the patient has carotid bruits (these plaques can break off and lead to stroke).
|
|
|
Which test is used to diagnose neeurocardiogenic syncope?
|
Tilt-table test
|
|
|
How does tilt-table testing work?
|
It causes a postural decrease in ventricular filling which increases sympathetic activity and ventricular contraction. This increased contraction is sensed by mechanoreceptors and vagal tone is increased.
|
|
|
Which diagnostic test is used to assess SA and AV node disorders and tachyarrhythmias?
|
Electrophysiologic studies
|
|
|
What are some causes of cardiac arrhythmia?
|
- Metabolic abnormalities
- Illness (CHF, sepsis) - Foods/Beverages -Prescription/Non-Prescription medications |
|
|
Which classification system is used to pharmacologically treat cardiac arrhythmia?
|
Vaughn Williams Classifications
|
|
|
List the sodium channel blockers in order of their potency (most to least).
|
IC
IA IB |
|
|
Which class IA agent produces a lupus-like syndrome as a side effect?
|
Procainamide
|
|
|
When should you NOT use disopyramide?
|
When the patient has LV dysfunction
|
|
|
Which of the class IA agents has alpha-blocking effects?
|
Quinidine
|
|
|
Should class IB agents be used for supraventricular arrhythmias?
|
NO- used for ventricular arrhythmias only.
|
|
|
Which class IB agent can be used via IV for ventricular arrhythmias but is also effective for ischemic related arrhythmias?
|
Lidocaine
|
|
|
Phenytoin can be used for arrhythmias that are resultant from what?
|
Digoxin toxicity
|
|
|
Which class IC drug can cause sudden death?
|
Flecainide
|
|
|
Beta blockers (Class II) are contraindicated in patients with what cardiovascular condition?
|
Wolff-Parkinson-White (WPW) Syndrome (because a slow AV conduction may facilitate conduction down a bypass tract)
|
|
|
What are Class III agents?
|
Potassium channel blockers
|
|
|
Pulmonary function should be closely monitored when using what class III agent?
|
Amiodarone (because its side effects include pulmonary fibrosis and cyanosis)
|
|
|
Can amiodarone be used for supraventricular or ventricular arrhythmias?
|
Both
|
|
|
List the 5 discussed Class III agents.
|
1. Amiodarone
2. Ibutilide 3. Sotalol 4. Bretylium 5. Dofetilide |
|
|
Which pharmacologic class consists of calcium channel blockers?
|
Class IV
|
|
|
When is adenosine used?
|
During rapid atrial tachyarrhythmias (used to help reveal underlying rhythm)
|
|
|
Which drug enhances vagal tone, slowing the rate through SA and AV node and can be administered PO or IV?
|
Digoxin
|
|
|
List 4 indications for implantation of a cardiac pacemaker.
|
1. Mobitz I/Wenkebach 2nd Degree AV Block
2. Mobitz II 2nd Degree AV Block 3. Complete heart block (3rd Degree) 4. Symptomatic Bradycardia |
|
|
Radiofrequency catheter ablation is most effective for VT in what patients?
|
Patients with no history of MI
|
|
|
Does AICD monitor the QRS?
|
No, it monitors heart rate.
|
|
|
What are some indications for use of AICD?
|
- Survival of VF
- Hemodynamically unstable VT - Patients at high risk after MI |
|
|
What is normal sinus rhythm (how many bpm)?
|
60-100
|
|
|
This rhythm disturbance is characterized by sinus pauses, conduction abnormalities, persistent bradycardia and usually indicates the need for a permanent pacemaker.
|
Sick sinus syndrome (usually caused by degenerative changes to the SA node)
|
|
|
What is the usual heart rate range for ectopic atrial tachycardia?
|
120-140 beats per minute
|
|
|
What is the typical treatment for ectopic atrial tachycardia?
|
Beta blockers
Calcium channel blockers Catheter ablation |
|
|
What defines multifocal atrial tachycardia?
|
3 or more "p" wave morphologies at >100bpm
|
|
|
This rhythm disturbance is seen mostly in patients with underlying lung diseases.
|
Multifocal Atrial Tachycardia
|
|
|
The typical atrial rate for atrial fibrillation is _______ beats per minute.
|
400-600
|
|
|
On an EKG, what distinguishes atrial fibrillation from atrial tachycardia?
|
A lack of "p" waves
|
|
|
List some precipitating factors leading to atrial fibrillation.
|
- HTN
- Thyrotoxicosis - Valvular heart disease - Heart failure - "Holiday Heart" (acute alcohol ingestion) - Pulmonary emboli |
|
|
What are the 3 forms of treatment for atrial fibrillation?
|
1. Hypercoagulation
2. Cardioversion 3. Heart rate control |
|
|
What is first line of treatment in hemodynamically unstable patients?
|
Immediate cardioversion
|
|
|
What is the only exception to anticoagulation in a patient suffering from AF?
|
A patient younger than 60 who has "lone atrial fibrillation"
|
|
|
This rhythm disturbance has an atrial depolarization rate of 250-350bpm and a ventricular rate of 150bpm.
|
Atrial flutter
|
|
|
What is the hallmark indication of atrial flutter on an EKG?
|
Sawtooth pattern
|
|
|
What is it called when the AV node overtakes the atria for a single beat?
|
Premature junctional complex
|
|
|
A ___________ occurs when the AV node takes over the _______.
|
Junctional escape rhythm, atria
|
|
|
What is the most common paroxysmal SVT?
|
AV Nodal Reentrant Tachycardia
|
|
|
What can terminate a AVNRT episode?
|
Vagal maneuvers (cough, etc.)
|
|
|
What is the hallmark indication of Wolff-Parkinson-White Syndrome?
|
Delta waves on the EKG
|
|
|
Why should you be careful when using drugs such as digoxin or calcium channel blockers to treat WPW Syndrome?
|
Because they slow conduction through the AV node and can lead to faster ventricular rates with concomitant AF or Af
|
|
|
What are two instances in which ventricular pacing may occur?
|
1. When primary pacemakers fail
2. Conduction is blocked from atria to ventricles |
|
|
How many beats per minute is a ventricular escape rhythm?
|
30-40bpm
|
|
|
What is the difference between sustained and non-sustained VT?
|
Sustained VT lasts more than 30 seconds and can cause hemodynamic instability
Nonsustained VT lasts less than 30 seconds |
|
|
If the QRS complex is wide, it is important to distinguish between SVT and VT. What are some finding suggestive of VT?
|
- Canon "a" waves
- History of CAD - First arrhytmia after MI - QRS is greater than 0.16 sec - Axis shift from baseline |
|
|
What is the treatment for stable VT?
|
- Antiarrhythmics
- Amiodarone is treatment of choice for long term treatment |
|
|
What is the treatment for UNSTABLE VT?
|
Cardioversion
AICD implantation if the patient has recurrent sustained VT |
|
|
How do you treat Torsades de Pointes?
|
IV magnesium
|
|
|
Treatment for VF consists of defibrillation at _______ joules.
|
200-360
|
|
|
This type of AV bock involves the prolongation of conduction to the AV node; the PR interval is greater than 0.20.
|
1st Degree AV Block
|
|
|
What is the difference between Mobitz I 2nd degree block and Mobitz II 2nd degree block?
|
Mobitz I: Gradual prolongation of the PR interval; No treatment is necessary
Mobitz II: No preceding lengthening PR intervals; May require a permanent pacemaker |
|
|
How do you treat complete heart block?
|
With a permanent pacemaker
|
|
|
This occurs when the atria and ventricles are depolariizing separately and the sinus rate falls below the lower level pacemaker.
|
AV Dissociation
|
|
|
What are 3 abnormalities that can lead to "Long QT Syndrome?"
|
Congenital
Drugs Metabolic |
|
|
If a patient endures a syncopade episode, what should the physical exam consist of?
|
- Check orthostatics
- Assess for murmurs - Neurological exam - EKG - Echocardiogram - Holter monitor - Tilt-table testing |
|
|
Define sudden cardiac death.
|
Natural, unexpected death occurring within one hour of symptoms.
|
|
|
What comprise the majority of causes of sudden cardiac death?
|
VT or VF in the setting of ischemic heart disease
|
|
|
How do you treat/prevent sudden cardiac death?
|
ONLY EFFECTIVE TREATMENT IS CPR AND ESTABLISHING A VIABLE CARDIAC RHYTHM.
|
|
|
The presence of the following in a post-MI patient indicate RISK for what condition?
Decreased EF, residual ischemia, NSVT on EKG, absence of heart rate variability, prolonged QT on EKG or induction of sustained VT |
Sudden cardiac death
|
|
|
Treatment for asystole?
|
Epinephrine
|
|
|
Treatment for bradycardia?
|
Atropine (then epinephrine)
|
|
|
Treatment for ventricular tachyarrhythmias?
|
Epinephrine
Lidocaine Amiodarone |
|
|
Treatment of VT from digoxin toxicity?
|
IV Phenytoin
|
|
|
Treatment of cardiac arrests due to tricyclic antidepressant overdose?
|
IV Sodium Bicarbonate
|
|
|
Treatment of hyperkalemia?
|
IV Sodium Bicarbonate
|
