ECG Lesson 1 Quiz Notes

Syncope

is a transient,self-limited loss of consciousness, is among the most common reasons for visiting an ED.

TAVR

Is a minimally invasive procedure used to replace a damaged aortic valve due to aortic stenosis(a heart condition where the aortic valve narrows and prevents blood going from heart to the rest of the body.) ,without open heart surgery.

VAD

ventricular assist device; a mechanical pump that helps a failing heart circulate blood when it can’t pump enough on its own.

After cardiac surgery among the patients who underwent surgical valve replacement/repair, permanent pacemaker implantation was required in

1.5-7.2%

Approximately 33% to 49% of patients undergoing surgical valve replacement/repair develop

A fib(Atrial fibrillation)

Regardless of the patient population, the need for monitoring should be reassessed every: 

24 hours on the basis of clinical and diagnostic findings and response to therapy

Which of the following drugs are known, with possible, and conditional risk for causing Torsade de pointes (TdP)

Citalopram

 Torsade de pointes (TdP)

is a rare and potentially fatal heart rhythm disturbance that occurs when the heart's lower chambers, the ventricles, beat faster and out of sync with the upper chambers, the atria.

Citalopram

 is a prescription medication used to treat depression

 Amiodarone

prevents and treats certain types of serious heart rhythm problems called arrhythmias

Azithromycin

is used to treat bacterial infections

Ciprofloxacin

Is a medication used to treat a variety of bacterial infections

In neonates and infants, AHA/ACC update prefers as what segment as a reference for the isoelectric line

TP segment

What is the highest current recommendation for ischemia monitoring

COR lla

COR(Class of Recommendation)

indicates the strength of a recommendation for a particular treatment and procedure

COR l

 is a strong recommendation that indicating established usefulness and effectiveness

COR llb

 is a weak recommendation where benefit is less certain

COR lll

is an action not recommended due to lack of benefit or potential harm.

Based on Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statements From The American Heart Association published by the American Heart Association on November 7th, 2017 the reason why COR I was transferred in COR IIa is that false alarm and nonactionable alarm signals will:

Distract the nurse, bother the patient, desensitize clinicians to respond to alarms

The authors of the 2004 practice standards1gave a COR I recommendation for continuous ST-segment monitoring to 4 patient populations (early phase of ACS; chest pain or angina-equivalent symptoms in patients presenting to the ED; after nonurgent percutaneous coronary intervention (PCI) with suboptimal angiographic results; and possible variant angina caused by coronary vasospasm), all of whom were at significant risk of myocardial ischemia, which, if sustained, could result in acute MI. After considerable discussion resulting in consensus, the AHA/ACC 2017 has given these patients a

 COR IIa recommendation

 The 2004 practice standards1recommended

1-mm ST-segment deviation as clinically significant for patients in critical care units at high risk of ACS

 Which of the following Class of Recommendation is described as reasonable to perform continues cardiac monitoring

COR IIa

 For arrhythmia monitoring in pediatric population which of the following lead is commonly selected

lead 2;

is commonly selected as a primary lead for continuous monitoring in the pediatric population because supraventricular arrhythmias are more common than ventricular arrhythmias, and P waves are often best visible in the inferior leads.

For arrhythmia monitoring in adults, which of the following lead is commonly selected because of its helpfulness in distinguishing between VT and aberrancy

V1;

Updated Clinical Statements and Guidelines – AHA Scientific Statement, November 7, 2017 reiterates the importance of two key points when implementing continuous arrhythmia monitoring are

-accurate lead placement 

-selection of the appropriate leads to monitor

According to American Heart Association (AHA) scientific statement on practice standards for electrocardiographic monitoring in hospital settings published in 2004 indications for continues and intermittent cardiac monitoring are

 -Identification of drug induced prolonged QT intervals

- Detection of acute myocardial infarction and

-Identification and diagnosis of complex cardiac arrhythmias

Which of the following medication caries a risk of Torsade de Pointes (TdP) and inpatient electrocardiographic monitoring is required by the US Food and Drug Administration for 3 days during initiation because of the risk of QT prolongation and ventricular arrhythmias

Dofetilide