Cards: Heart Failure, Arrhythmia

Front 1

What valvular diseases cause left sided diastolic failure?

Back 1

AS, MS, AR

Front 2

What sort of heart disease is caused by Paget's disease of bone?

Back 2

High output heart failure

Front 3

What is a skin finding in class IV heart failure?

Back 3

diaphoresis, cool extremities at rest

Front 4

What is the best location, and method of hearing an S3?

Back 4

Apex with bell

Front 5

What is are night time findings in heart failure?

Back 5

nocturia due to leg elevation

PND
orthopnea

Front 6

What is the EF cutoff for systolic vs diastolic failure?

Back 6

EF < 40 systolic
EF > 40 diastolic

Front 7

What are tests that can be used to estimate EF?

Back 7

Radionuclide testing
Echo
Cath

Front 8

What test should be done in case of flash pulmonary edema in CHF?

Back 8

coronary angiography

Front 9

What are indications for dig in CHF?

Back 9

EF < 30
severe CHF
severe a-fib

Front 10

What drugs should always be used in heart failure, even if asymptomatic?

Back 10

ACE inhibitors

Front 11

How long must one be stable before initiating beta blockers in heart failure?

How long does it take for symptomatic improvement following administration of drug

Back 11

2-4 weeks

2-3 months before symptomatic improvement

Front 12

Which heart failure drug dosage should be maximized?

Back 12

beta blocker

Front 13

What are alternatives if ACEI can't be used in heart failure?

Back 13

ARB
hydralazine, isosorbide dinitrates

Front 14

In which heart failure patients should aldosterone antagonists be used?

What are some things to look out for?

Back 14

Class III/IV failure
already receviing dig, diuretic, ACE inhibitor, beta blocker

Watch out for renal insufficiency
Watch out for hyperkalemia with ACE inhibitor use
Give only if LVEF <35%, Cr <2.5, K < 5

Front 15

What is a good combination of drugs to start heart failure patients on?

Back 15

ACE inhibitor, diuretic combo

Front 16

Which drug classes are useless in diastolic failure?

Back 16

vasodilators and inotropes

Front 17

Etiology of premature atrial complexes?

Back 17

Adrenergic excess

Drugs
Alcohol
Tobacco
Electrolyte imbalances
Ischemia
Infection

Front 18

Management of PACs?

Back 18

do not require meds if asymptomatic
Beta blockers if symptomatic

Front 19

Etiology of premature ventricular complexes

Back 19

Hypoxia
Electrolyte abnormalities
Stimulants
Caffeine
Medications

Front 20

Management of PVCs?

Back 20

do not require meds if asymptomatic
Beta blockers if symptomatic

Front 21

What are ventricular rates in a-fib?

Back 21

75-175

Front 22

What is holiday heart syndrome?

Back 22

a-fib due to excessive alcohol intake

Front 23

What other arrythmia does sick sinus rhythm predispose patients to?

Back 23

a-fib

Front 24

What arrythmia occurs with pheochromocytomia, hypo and hyperthyroid?

Back 24

a-fib

Front 25

Rate control in a-fib?

Back 25

Ca channel blockers are first line
Beta blockers are second line
If LV systolic dysfunction consider amiodarone or dig

Target rate is 60-100

Front 26

Cardioversion strategy in acute a-fib?

Back 26

Cardiovert only after rate is stabilized

Do within 48 hours

Electrical cardioversion first
If it fails try with meds:
ibulitide, procainimide, flecanaide, sotalol, amiodarone

Front 27

Cardioversion strategy in chronic a-fib?

Anticoagulation INR goal?

Back 27

anticoagulate 3 weeks before and 4 weeks afterwards

If cardioversion is to be done before hand do TEE to evaluate for thrombus and then anticoagulate for 4 weeks afterwards

keep INR between 2-3

Front 28

Atrial flutter atrial and ventricular rate?

Back 28

250-350 atrial
one half to one third ventricular

Front 29

Most common etiologies for atrial flutter?

Back 29

COPD
Heart Disease - rheumatic heart disease, CAD, CHF
ASD

Front 30

How should atrial flutter be treated?

Back 30

like a-fib

Front 31

Etiology of multifocal atrial tachycardia?

Back 31

Usually COPD

Front 32

Diagnosis of multifocal atrial tachycardia?

Back 32

3 different p waves needed
Vagal maneuvers or adenosine to show AV block without disrupting tachycardia

Front 33

Treatment of multifocal atrial tachycardia?

Back 33

O2, improved ventillation

if LV function is preserved --> ca channel blockers, beta blockers, digoxin, amiodarone, IV flecanide, IV propafenone
If LV function is not preserved --> digoxin
Don't cardiovert, it doesn't work

Front 34

What is the most common SVT?

Back 34

AV nodal reentrant tachycardia

Front 35

What is the bookend of a AVNRT and orthodontic AV reentrant tachycardia?

Back 35

PACs intiate and terminate AVNRT
PAC, PVC intiate and terminate ordontic AV reentrant tachycardia

Front 36

Etiology of paroxysmal supraventricular tachycardia?

Back 36

Ischemic heart disease
Dig toxicity (paroxysmal a-tach with 2:1 block
AV nodal reentry
Atrial flutter with rapid ventricular response
AV reciprocating tachycardia
Excessive caffeine, alcohol consumption

Front 37

Treatment of acute paroxysmal supraventricular tachycardia?

Back 37

Valsalva maneuver, carotid sinus massage, breath holding, head immersion in cold water

Acute Rx
IV adenosine
IV verapamil, esmolol, digoxin if preserved left ventricular function
DC cardioversion if drugs are not effective, unstable

Front 38

Prevention of paroxysmal supraventricular tachycardia?

Back 38

Digoxin is drug of choice
Verapamil, beta blockers

Radiofrequency catherter ablation of AV node or accessory tract
Only do this if recurrent and symptomatic

Front 39

What is hte direction in which the current flows in an orthodromic WPW?

Back 39

anterograde AV conductance, retrograde accessory conductance

Front 40

Pharmacological therapy for WPW?

Back 40

Avoid AV nodal blocking agents
Use Type IA, IC antiarrhythics

Front 41

Rate of ventricular tachycardia?

Back 41

100-250

Front 42

Etiology of V-tach?

Back 42

CAD with prior MI is most common cause
Active ischemia, hypotension
Cardiomyopathies
Congenital defects
Prolonged QT
Drug toxicity

Front 43

Clinical features of Vtach?

Back 43

Cannon a waves in neck (secondary to AV dissociation - atrial contraction during ventricular contraction)

Front 44

V-tach changes with vagal maneuvers or adenosine?

Back 44

No changes. Useful in diagnosis

Front 45

Treatment of sustained v-tach?

Back 45

if hemodynamically stable, mild symptoms and systolic BP > 90 --> IV amiodarone, IV procainamide, IV sotalol

Hemodynamically unstable, symptoms --> immediate cardioversion, IV amiodarone

ICD placement unless EF is normal (--> amiodarone)

Front 46

Treatment of nonsustained v-tach?

Back 46

If no underlying heart disease and asymptomatic --> no treatment

If underlying heart disease, recent MI, LV dysfunction, symptoms --> EP study
If inducible, sustained VT --> ICD placement

Pahrm is second line treatment --> Amiodarone

Front 47

What is good for v-fib prophylaxis. In what cases is it considered?

Back 47

Non MI associated v-fib recurrs very often

Amiodarone or AICD

Front 48

Etiology of v-fib?

Back 48

ischemic heart disease
Antiarrhythmics
a-fib in WPW

Front 49

Treatment of v-fib?

Back 49

Immediate defibrillation and CPR
3 sequential shocks, assess rhythm between each
Epinephrine 1 mg and then every 3-5 minutes

refractory v-fib
amiodarone followed by shock
lidocaine, bretylium, magnesium, procainamide

continue IV antiarrhythmic after successful cardioversion
Implant defibrillator if continued risk