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131 Cards in this Set
- Front
- Back
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how long should the P wave be?
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< 0.1seconds
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what is the length of the ORS complex?
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0.05-0.1 seconds
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what is the appropriate length of the QT interval?
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<0.5 seconds
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what does the p wave show?
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atrial depolarization
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what is the ventricular depolariziation?
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QRS complex
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what wave is the ventricular repolarization>
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T wave
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what is the area for the vent depolarization and repolarization?
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QT interval
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What is phase 0?
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-depolarization
--rapid Na entry --slow Ca entry |
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what is phase 1
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repolarization
-K expulsion |
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what is phase 2
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the plateau
--slow entry of Ca --Slow K expulsion |
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what is phase 3?
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resting potential
--K expulsion |
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what is the Quiescence stage of the chart?
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phase 4:
--Na exits --K reenters |
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what are the characteristics of pediatric arrhythmias?
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-unknown incidence
-incidence increases with age -common comorbidities in paitents with VALVULAR HEART DISEASE or HF -More in males |
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Differential diagnosis for arrhythmias differs for __ and __ children
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asymptotic and symptomatic
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____ children with an incidental arrhythmic finding are usually benign
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asymptomatic
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symptomatic children with ___ presentations usually require ___
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clinical; intervention
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when are asymp arrhyths detected>
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usually during routine physical
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what are the most commonly presented asymp arrhythmias?
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-sinus arrhythmia
-ventricular premature beat -atrial premature beat |
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Sinus Arrhyth is a normal physiologic variant with ___ HR during inspiration and __ HR during expiration
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increase; decrease
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what causes sinus arrhyth?
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changes in parasympathetic input to the heart
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How do you diagnose sinus arrhyth?
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ekg
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what is another name for VPBs?
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PVCs
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what is a PVC?
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premature depolarization of the vents leading to early systolic contractions
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a PVC is usually followed by a __ leading to __ heart rates and __ patterns
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pause; irregular; irregular
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ToF: PVC can cause hemodynamic compromise
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true:
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what should you think if you see a child in the summer with a PVC?
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enterovirus
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what can you give to a child with PVCs that usually takes them away?
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Mg
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How may PVCs present?>
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Bigeminy and Trigeminy
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What is another name for the APBs?
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PACs
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what is a PAC?
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early depol of atrial myocardium leading to propagation of electrical impulses through the atrium
-results in rearly systolic vent contractions |
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PACs are rarely associated with ___
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tachyarrhythmias
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The underlying etiology of symptomatic arrhyths may be due to a sustained ___
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tachyarrhthymia
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what are the clinical symptoms often present for arrhythmias?
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-palpitations
-syncope -chest pain |
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what are the types of supraventricular arrhythmias?
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-A fib
-paroxysmal supraventricular tachy |
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what is acute A fib?
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onset within 48 hours
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what type of A fib has an abrupt start, converts spontaneously within 7 days?
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paroxysmal
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what is persisten A fibv?
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does not convert spontaneously, lasts longer than days
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what is permanent A fib?
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doe not terminated with any treatment
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___ episodes of A fib put it in the category of recurrent
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> or = 2
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what are the goals of A fib therapy?
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-Rate control
-STROKE PREVENTION -Normal sinus rhythm conversion |
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what type of therapy should every A fib patient get? which one do only some receive?
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all get RATE CONTROL
some get Rhythm control |
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What are the drugs used for rate control of A fib?
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-beta blockers
-non-dihydropyridine calcium channel blockers -digoxin -amiodarone |
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what is the MOA of beta blockers?
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block effect of symp neurotransmittiers (norepi) ont he heart and vasculature
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beta blockers __ vent arrhytmias; __ vent response rate; ___ AV nodal conduction; __impulse transmission
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Decrease to all
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what is the acronym for the B1 beta blockers?
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BEAMN
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What are the generic names of the Beta blockers from lecture?
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-Bisoprolol
-Esmolol -Atenolol -Metropolol -Nebivolol -Propanolol |
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Which beta blockers are PO?
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BAMNP
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Which are the beta blockers that can be given IV?
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MEAP
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what are the adverse effects of the beta blockers?
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-hypotension
-decrease HR -AV BLOCK -fluid retention -depression -fatigue -sexual dysfunction |
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what are the cautions for beta blockers?
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-severe bronchospastic disease: asthma
-bradycardia -symptomatic Hypotension -2nd and 3rd degree heart block |
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what should be monitored for beta blockers?
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-weight
-BP -HR -HF symptoms -adverse effects |
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Which groups of patients should all be on beta blockers?
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those needed rate control that have normal left ventricular function
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tof: BBs can be used for chronic rate control in patients with normal or impaired left vent function?
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true
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__ doses of BB are needed for acute rate control compared to HR
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higher
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IV route of BB is preferred for __ rate control
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acute
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what are the MOA of NDCCBs?
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decrease influx of calcium
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the NDCCBs __vent arrhythmias; __ventr response rate; __ AV nodal conduction; ___ impulse transmission
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decrease to all
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what are the 2 NDCCBs?
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Diltazem (Cardizem, Tiazac)
Verapamil (Calan, Verelan) |
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which of the NDCCBs are PO, which are IV?
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both can be used both ways
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what are the adverse effects of the NDCCBs?
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-hypotension
-decrease HR -fluid retention -dizziness -flushing -constipation (give stool softeners) |
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what are the cautions with NDCCBs?
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-sick sinuse syndrome
-wolff-parkinsons white syndrome -2nd and 3rd heart block |
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NDCCBs monitoring include?
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vitals
HF symps adverse effects |
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what drugs are the agent of choice for acute rate control?
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ND CCBs
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which patients should not be given ND CCBs?
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those with impaired left ventricular function
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IV route of NDCCB is preferred for acute management of rate control but not to exceed ___
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48 hours
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what is the MOA of Digoxin?
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inhibition of Na=K adenosine triphosphatase
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Digoxin __ ventricular arrhyths; __AV node activation through vagal tone; __ refractory period; __ventricular impulses; ___ventricular response rate
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decrease; increase; increase; decrease; decrease
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WHat are the route options for digoxin>?
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IV and PO
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What are the adverse effects of digoxin?
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-dig toxicity can be fatal
-cardiac toxicities (vent arrhytmias, heart blocks, brady) -GI disturbances (NV) -CNS toxicities (confusion and vision changes) |
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the risk for adverse effects of digoxin include...
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-decrease K
-decrease Mg -increase Ca -hypothyroidism -interacting medications -renal insufficiency |
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digoxin is contraindicated in ___
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2nd and 3rd degree heart block
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What should be cautioned with digoxin?
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-amiodarone
-diuretics -cholestyramine -spironolactone -verapamil NDCCB |
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what are the monitoring keys for digoxin?
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-BMP (K, S. Cr)
-therapeutic levels (1-2) -vitals: HR -HF symps -SxS of toxicity |
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when is increased digoxin monitoring required?
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1. change in renal funciton
2. change in EKG 3. SxS of toxicity 4. initiation or discontinuation of interacting medications |
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ToF: digoxin should be used for acute control of rate?
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false
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If a child is also on amiodarone, how should digoxin be given>
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decrease the dose by 50%
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IV therapy of digoxin is given to who?
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ONLY reserved for patients unable to take oral medications
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when should the starting dose of dig be decreased?
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patients with conduction abnormalities, decreased renal function, low lean body mass
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What are the drugs used for normal sinus rhythm conversion?
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-Doeftilide
-Flecainide -Propafenone -Sotalol -amiodarone |
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what is the chart used to determine the class of anti-arrhythmic and where it falls on the grid?
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Vaughn Williams Classification
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ToF: all of the anti-arrhythmics can be given IV and PO
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false: all are only PO
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What are the class Ic anti-arrhythmics and what do they block?
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-Flecainide
-Propafenone work on the Na channel |
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What is the only antiarrhythmic in class II and III? where does it work?
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sotalol
acts on the B-adrenergic and K channel |
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what are the class III anti-arrhythmics?
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dofetillide and sotalol
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What is the only drug under the vaugh williams class that can be given IV?
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lidocaine
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What is the MOA of dofetilide?
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class III anti-arrhyth
-blocks K channel to increase action potential due to delayed repolarization |
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Dofetilide has no effect on...?
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-sodium channels
-adrenergic alpha receptors -adrenergic beta receptors |
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what are the adverse effects of Dofetilide?
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-Hypotension
-Decrease HR -QT prolongation -syncope -dizziness |
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What are the cautions for patients on Dofetilide?
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-QTc> 440msec
-Cr Cl < 20 ml/minute -Concurrent use of verapamil |
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what should be monitored for Dofetilide?
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-vitals: hr, bp
-EKG: rhythm, QT -BMP -Adverse effects |
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ToF: dofetilide is safe and effective in heart failure patients
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true
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Prolonged QT requires a ___dose reduction of dofetilide
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50%
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ToF: dofetilide has the potential for proarrhythmic effects
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true
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What is the MOA of sotalol?
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Beta blocker effects:
--beta adrenoreceptor-blocking properties --cardiac action potential prolongation Class II effects: --beta adrenergic blockade Class III effects: --blocks K channels |
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What are the adverse effects of Sotalol?
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-hypotension
-decrease hr -AV BLOCK -QT PROLONGATION -Arrhythmias -dizziness -fatigue |
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Whta are the cautions with sotalol?
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-severe bronchial asthma
-2nd and 3rd degree heart block -uncontrolled heart failure -renal failure |
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For Sotalol, doses can be titrated ONLY after ____ doses have been administered.
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5-6
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how is sotalol administered?
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PO bid
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When should sotalol be decreased or discontinued?
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if QT prolongation exceeds 25% of baseline
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Sotalol may mask the symptoms of ___
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hyperthyroidism
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What is the MOA of flecainide?
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Class Ic
Blocks Na channels to prolong refractory periods and increases electrical thresholds |
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Flecainide has moderate ___effects
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inotropic
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what are the adverse effects of Flecainide?
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-Ventricular arrhythmias
-dizziness -visual disturbances -dyspnea -worsening HF |
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what is the only antiarrhythmic cautioned with 1st and 2nd degree heart block? what is another caustion of this drug?
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flecainide
renal disease |
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when in flecainide absolutely contraindicated?
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with CHF
and post MI |
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Flecainide is the drug of choice for ___ patients
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non-heart disease
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Flecainide should have the dose titrated by lowerst possible dose not more often than ___
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once every week
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flecaininde should be decreased by 50% with impaired ___
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renal function
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what is the MOA of Propafenone?
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Ic antiarrhythmic
blocks Na channel to prolong refractory periods and increases electrical thresholds -exhibits some Beta blockade activity |
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List the adverse effects of Popafenone?
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-QT prolong
-bronchospams -Impaired taste sensations (creamy, slimy, milky) -decrease HR -worsening HF -dizziness -arrhythmias |
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When should propafenone be cautioned?
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-severe brochial asthma
-congestive HF -liver disease -Elevated ANA titers |
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what should be monitored for propafenone?
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vitals
ekg LFTs CBC LUPUS PANEL |
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Propafenone should be titrated not more than every ___ days.
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4-5
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The dose of propafenone should be reduced by 25-50% in patients with ...?
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1. Liver disease
2. QRS widening 3. Heart block |
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ToF: propafenone comes in a form of immediate release and sustained release for taylored control
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true
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which class of the vaughn williams classification does amiodarone fit in?
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ALL OF THEM!!
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what are the many actions of amiodarone?
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sodium blockade
beta blockade K blockade Ca blockade |
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ToF: calcium blockade with amiodarone is more effective with IV over many hours
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false they are equal with for IV/PO for all time frames
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what route of amiodarone gives the highest rate of K blockade?
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strongest PO over weeks
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ToF: amiodarone stays in the body for months
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true
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what are the adverse effects of amiodarone>
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-Decrease BP and HR
-QT prolong -Phlebitis -AV block -pulm fibrosis -optic neuropathy -hepatitis -hypo/hyperthyroidism -BLUE GRAY SKIN DISCOLORATION b/c of iodine |
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when is amiodarone cautioned?
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-iodine allergies
-2nd and 3rd heart block -heaptic disease -drug interactions (warfarin) -QT prolong |
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what should be monitored with amiodarone?
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BP, HR
-EKG -Pulmonary testing -Thyroid testing (iodine) -ophthalmic -adverse effects |
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which route for amiodarone is preferred or symptomatic patients?
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IV
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ToF: amiodarone should not be used in patients with A Fib and HF?
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false: safe and effective in both
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What does the FDA require of patients on amiodarone?
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to get drug -info patient education leaflet
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what are the stroke preventions?
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-asparin
-warfarin -lovenox |
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what is CHADS2?
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the test for risk of stroke
-Chronic heart failure? -Hypertention? -Age >75? -Diabetes? -Stroke (prior) 2 points |
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Impaire heart function --> blood stasis ..> ___ risk of clots and strokes
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increase
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when is aspirin used and what is the caution?
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-depending on risk, first choice for primary prevention
-caution in children with viral illness : increase in reyes |
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when is warfarin used and cautioned? What is monitored?
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-increase adverse effects with genetic variations
-purple toe syndrome -INR: 2-3 |
