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