Cardiology

Front 1

blood supply to SA node

Back 1

RCA (55%)
Left circumflex (45%)

Front 2

blood supply to the AV node

Back 2

RCA ( 90%)
left circumflex (10%)

Front 3

Coronary vascular territory

Back 3

Anatomic Region of Heart-------Coronary Artery (most likely associated)
Inferior-------Right coronary
Anteroseptal--------Left anterior descending
Anteroapical------Left anterior descending (distal)Anterolateral-----Circumflex
Posterior--------------Right coronary artery

Front 4

DDX considerations for bradycardia

Back 4

Electolyte disorders

drugs (digitalis, B-Blockers, amiodarone, propofol)

Infection (typhoid, leigonaire's, malaria, dengue)

Infarction

Front 5

Tx for bradydysrhytmias

Back 5

Atropine (0.5-1mg q 3-5 minutes- max 3mg)

Glucagon (for B-Blocer/CaChannel blocker toxicity)

Dopamine (2-10 mcg/minute infusion)

Artificial Pacing (Transcutaneous, transvenous, transthoracic)

Front 6

Major mechanisms for brady- and tachydysrhythmias

Back 6

disorders of impulse formation

disturbance of conduction

Front 7

sinus bradycardia

Back 7

sinus rhythm <60 bpm

Front 8

sick sinus syndrome

Back 8

spectrum of conditions includingsevere sinus bradycardiaSA blocksinus arrest bradycardia-tachycardia syndrome (intermittent brady and tachydysrhytmias- inc. a.fib/flutter, PVST- in the same patient)

Front 9

AV Juntional Rhythms

Back 9

-intrinsic rate approx 45-60 bpm
-occur in the abscence of sinus stimulus or with rapid juntional foci firing

-typical QRS morphology is similar to pt's sinus beats

-retrograde P waves

-junctional escape beat typically occurs after an interval longer than the dominant cycle

Front 10

ventricular escape rhythm- rate?

Back 10

-rate = <50 bmp

-drugs that may abolish ventricular rhythm may cause asystole and are contraindicated !(i.e Lidocaine, amiodarone)

Front 11

1st degree AV Block

Back 11

PR interval > 200ms
-all p-waves conducted

-constant P-R, and R-R intervals

-can be associated with electrolyte disturbances, digitalis, Ca+ Chanel blockers, AMI (esp inferior MI)

Front 12

Mobitz tple I 2nd degree AV Block (Wenchebach)

Back 12

-usually results from conduction delay in the AV node (but may ;be seen with lower conduction tissue block)

-usually normal duration ORS

-progressive prolongation of the PR interval, then dropped QRS

-usually transient, asymptomatic and carries a good prognosis

Front 13

Mobitz Type II 2nd degree AV block

Back 13

-constant PR interval with intermittent dropped beats
-site of block is usually within the His-Purkinje system
-typically seen with a BBB, wide QRS complex
-often symptomatic, high rate of progression to 3rd degree AVB

-requires permenent cardiac pacing

Front 14

3rd degree AV block

Back 14

-no atrial impulses reach the ventricles
-block site may be AVN/His-Purkinjee/Bundles

-requires perment pacemaker placement

-consider atropine/emergent pacer if symptomatic

Front 15

Indications for temporary pacemaker

Back 15

-Any hemodynamically unstable bradydysrhymia refractory to pharmacologic therapy

-Acute MI and
-1st degree ACB + new onset BBB
-Tyle II 2nd degree AVB
-3rd degree AVB
-RBBB + LAFB or LPFB
-LBBB and Swan Ganz placement (b/c risk of iatrogenic RBBB)

Front 16

Pacer settings

Back 16

-Maximal output setting until capture is acheived,
then decrease as tolerated

-typical initial rate = 80-100 bpm

-asynchronous mode--> cardiac arrest

-synchronous mode--> bradydysrhytmias

Front 17

complication from central line/swan in pt with LBBB

Back 17

complete heart block (moderater band with RBB disruption)

Front 18

chronotrope

Back 18

effects heart rate

Front 19

ionotrope

Back 19

effects strength of myocardial contraction

Front 20

dysrhythmias due to pressors

Back 20

due to beta on stimulations-highest incidence with dopamine

Front 21

PSVT

Back 21

includes AVNRT
- duel pathways in he AV node-most common

AVRT
-requires an accessory path-ex. WPW

Front 22

management steps for tachycardia

Back 22

1. be prepared for cardiac arrest
2. determine stability
3. determine rate
4. determine QRS width(>.12=wide)narrow- always supraventricular
5. assess regularity of RR intervals
6.determine presence or absence of a p wave

Front 23

tachycardia

narrow, regular, with p waves

Back 23

sinus tachycardia(most common)

PAT (rare)

Front 24

tachycardia- ddx---
narrow
regular
no p waves

Back 24

AVNRT
AVRT
atrial flutter with block

Front 25

PSVT treatment

Back 25

vagal maneuvers - valsalva, carotid massage, ice water immersion

pharmacotherapy
-adenoside-1st line-verapamil or diltizem ( if not contraindicated )
-esmolol (less effective)

Front 26

dig effect on EKG

Back 26

PR prolongation plus ST segment scooping

Front 27

two mechanisms for tachydysrhymias

Back 27

re-entry and enhanced automaticity

Front 28

;Atrial flutter treatment

Back 28

extremely electrosensitive (cardioversion!)

-amiodarone can be used for chemical cardioversion

**careful with drugs that speed up AV nodal conduction (ex. procainamide), these can increase conduction of flutter waves!

Front 29

Tachycardaia-
Ddx
Narrow, irregular, P waves present

Back 29

MAT-most common in chronic lung disease patients

Front 30

tachycardia
Ddx
narrow, irregular, no P waves

Back 30

Atrial fibrillation
a flutter with variable block

Front 31

treatment for A.fib

Back 31

rate control
Diltiazem (5-10mgIV over 2 min, q5min, max total 50-60mgiver 30 minutes, then gtt@ 5-15 mg/h)

alternatives- verapamil, B-Blockers, digoxin, magnesium)

cardioversion- hemodynamic instability
electrical
chemical-amiodarone

anticoagulation

**may require pacemaker if spontaneous slow ventricular repsonse

Front 32

tachycardia-ddx

wide, regular , no p waves

Back 32

monomorphic V tach
PSVT with aberrancy (BBB)antiodromic WPW

***For treatment purposes, safest to treat as VT

Front 33

Ventricular tachycardia-treatment

Back 33

Unstable- synchronized electrical cardioversion, then antiarrythmic infusion (below)

Stable-
Amiodarone (150mg IV over 10 minutes, the gtt at 1mg/min
OR Procainaminde (17 mg/kg bolus, max rate 50mg/min)
Lidocaine (100mg IV bolus)Magnesium ( 2-4g IV over 5 minutes, then 1 g/hour)

Front 34

tachycardia-DDX
Wide,; irregular,no p waves

Back 34

AF with BBB
AF with WPW
polymorphic VT (including TdP)
VF

Front 35

Wide comlex A.fib- treatment considerations

Back 35

due to BBB
- tx similar to narrow a. fib

agents that slow condution through AV note are CONTRAINDICATED (i.e diltiazem, BBlockers, digitalis; theses will increase conduction through a bypass tract

best treated with electrical cardioversion, then amiodarone/procainamide to prevent recurrence

--due to WPW

Front 36

Torsades de Pointes

-causes, treatment

Back 36

-drugs! (antiarrythmics, phenocthiazines)

-electrolyte disturbances(hypocalcemia, hypokalemia)

Treatment
-magnesium (2-4g over 5-10 minutes)
-replete K
-avoid QT prolonging agents (including amiodarone!)

Front 37

Ventricular fibrillation

Back 37

defibrillation
Biphasic 100J-200J
Monophasic 200J-360J

After sucessful defibrillation, start IV amiodarone, lidocaine or procainamide gtt to prevent further arrythmia