Im Cv Arrhythmias Usmle 2

Front 1

What does "irregularly irregular" mean on an ECG?

Back 1

Irregular RR intervals

Front 2

Irregularly irregular rhythm without p-waves prior to each QRS

Back 2

Atrial fibrillation

Front 3

Etiologies of A-Fib (10)

Back 3

PIRATES:
Pulmonary (COPD, PE), Pheochromocytoma, Pericarditis;
Ischemic heart dz, HTN;
Rheumatic heart dz;
Anemia;
Thyrotoxicosis;
Ethanol (& cocaine), Endocarditis;
Sepsis

Front 4

Signs/symptoms of A-Fib (5)

Back 4

A FL PT:
Asymptomatic patient;
Fatigue (most common);
Light headedness, syncope;
Palpitations, skipped beats;
Tachypnea, dyspnea

Front 5

Complication of A-Fib

Back 5

diffuse Embolization (often to brain, leading to TIA or stroke)

Front 6

One of two possible Drugs given to A-Fib to control rate in an emergent situation

Back 6

IV Calcium channel blocker: Diltiazem
(or)
IV Beta-blocker: Metoprolol

Front 7

Drugs given to A-Fib to control rate in a non-emergent situation (2)

Back 7

oral Beta-blocker:
Atenolol
(and)
oral Calcium channel blockers:
Verapamil or Diltiazem

Front 8

what are the (2) ways to cardiovert an A-Fib rhythm?
when should you not cardiovert?
what would the Tx be then?

Back 8

Medical: Amiodarone

Electrical: start at 100 J Do not cardiovert if patient is in A-Fib > 24 hours.

Tx: Warfarin for 3-4 weeks before cardioversion

Front 9

If cardioversion from A-Fib to sinus rhythm does not occur, what should patient be treated with?

Back 9

Long-term anticoagulants DOC:
Warfarin (1st)
Aspirin (2nd)

Front 10

how many seconds and boxes is a normal PR interval?

Back 10

0.2 ms 5 small boxes

Front 11

define:
Q-wave

When is it pathologic?

Back 11

when initial part of ventricular depolarization is downward

Pathologic: greater then 1 small box

Front 12

normal time and boxes for QRS interval?

Back 12

< 0.12 ms 3 small boxes

Front 13

normal sinus rate

Back 13

60 - 100 bpm

Front 14

define:
Junctional rhythm

Back 14

rhythm originating in the AV node and causing narrow QRS w/o P-waves

Front 15

Dx:
no p-waves; all complexes are wide; no changes in height (amplitude) w/ each complex; > 100bpm

Back 15

Ventricular tachycardia

Front 16

Dx:
wide QRS complexes that vary in amplitude
(2 names)

Back 16

Ventricular Fibrillation

Torsades de Pointes

Front 17

Dx:
normal sinus rhythm w/ PR interval > 0.2 ms (> 5 small boxes)

Back 17

First-degree AV block

Front 18

Dx:
PR interval elongates from beat to beat until it becomes so long that a beat drops

Back 18

Second-degree AV block, type 1 (Wenckebach)

Front 19

Dx:
PR interval is fixed but every so often there is a P-wave w/o a QRS

Back 19

Second-degree AV block, type 2 (Mobitz)

Front 20

Dx:
no relationship b/t P-waves and QRS complexes

Back 20

Third-degree AV block

Front 21

Dx:
QRS > 0.12 (> 3 small boxes) RSR' in V1 + V2;
deep S-wave in lateral leads (I, aVL, V5 + V6)

Back 21

RBBB

Front 22

Dx:
QRS > 0.12 (> 3 small boxes);
RSR' in V5 + V6; diffuse ST elevation

Back 22

LBBB

Front 23

Dx:
Different shapes to 3 or more P-waves; normal rhythm
(what is it called if it is tachycardic?)

Back 23

Wandering pacemaker

MFAT: Multifocal Atrial Tachycardia

Front 24

Dx:
short PR interval; slurring delta wave connecting P-wave to QRS complex

Back 24

Wolff-Parkinson-White syndrome

Front 25

Dx:
diffuse ST elevation that slopes in a concave manner back to baseline + diffuse PR segment depression in all leads except PR elevation in aVR

Back 25

Pericarditis

Front 26

drug Tx of wandering pacemaker and MFAT?

Back 26

Verapamil (Ca channel block)

Front 27

what Tx breaks SVT (superventricular tachy) in > 90%?

Back 27

Adenosine (failure to break r/o SVT)

Front 28

Tx for V-tach w/ hypotension or no pulse

Back 28

Emergency defibrillation @ 200 - 360 J

Front 29

Tx of asymptomatic V-tach
(2 meds)

Back 29

Amiodarone

or

Lidocaine

Front 30

Tx of V-Fib

Back 30

Emergent electroshock @ 200 - 360 J

Front 31

how do you distinguish Paroxysmal Noctournal Dyspnea from asthma?

Back 31

no improvement w/ bronchodilators

Front 32

Dx:
SVT w/ AV block + yellow skin

Back 32

Digoxin toxicity

Front 33

How do you diagnose LVH from a ECG? (2)

Back 33

1. S-wave in V1 + R-wave in V5 or V6 > 7 large boxes (35 small)
2. R-wave in V5 or V6 > 25 small boxes
OR
R-wave in lead aVL > 11 small boxes

Front 34

Causes of prolonged QT (8)

Back 34

QT WIDTH:
QT: Prolonged QT syndrome
W: WPW
I: Infarction
D: Drugs
T: Torsades de pointes
H: HypoK, HypoC, Hypomagnesium

Front 35

What electrolyte disorder causes short QT segments?

Back 35

HyperC

Front 36

Causes of Torsades de Pointes (7)*

Back 36

POINTES:
Phenothiazines
Other meds (TCAs)
Intracranial bleed
No known cause (idiopathic)
Type 1 Anti-arrhthymics
Electrolyte abnormalities
Syndrome of prolonged QT

Hint 36

POINTES

Front 37

What can be given to a patient to temporarily slow a rapid supraventricular rhythm in order for you to be able to identify it?

Back 37

Adenosine

Front 38

What drugs should not be given to someone w/ Wolff-Parkinson-White syndrome?
(4)
What is the DOC?

Back 38

ABCD:
Adenosine
Beta-blockers
Calcium channel blockers
Digoxin

DOC: Procainamide

Front 39

Causes of Mobitz I (3)

Causes of Mobitz II (2)

Back 39

Mobitz I:
Inferior wall MI;
Digitalis toxicity;
Inc Vagal tone

Mobitz II:
Inferior or septal wall MI;
Conduction system disease

Front 40

Tx for Mobitz I & II
(2)

Back 40

Both:
Atropine & temporary pacing

(Mobitz II should have pacemaker)

Front 41

Causes of third-degree heart block (3)

Back 41

Digitalis toxicity;
Inferior wall MI;
Conduction system disease

Front 42

Causes of Bradycardia (6)

Back 42

if R-R is longer then "One INCH":
Overmedication;
Inferior MI / Inc intracranial Pressure;
Normal variant (athletes);
Carotid sinus hypersensitivity;
Hypoparathyroidism

Front 43

Tx for bradycardia (3)

Back 43

1. Atropine
2. pacing
3. pressors for hypotension

Front 44

a 24-yo woman w/ preclampsia Tx w/ IV drip of magnesium complains of difficulty breathing and has diminished reflexes.
Next step? (2 together)

Back 44

1. Stop magnesium

2. give IV calcium

Front 45

equation for Mean Arterial Pressure

Back 45

MAP = (2dBP + sBP)/3

Front 46

Dilation of which heart chamber is a major cause of A-fib?

Back 46

Left atrium