Studied by 6 people
What procedure can be used to destroy a critical region of impulse generation/propagation in the heart that is causing arrhythmias?
Ablation
What device is a small battery-powered electrical impulse generator that can be implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation?
Automated Implantable Cardioverter-Defibrillator (AICD)
How is severe, symptomatic sinus bradycardia treated?
Atropine, then pacemaker (if atropine is not effective)
What is another term for Sick sinus syndrome?
Sinus Node Dysfunction (SND)
How is sick sinus syndrome treated if the ejection fraction is normal?
Pacemaker
How is sick sinus syndrome treated if the ejection fraction is <35%?
AICD
What are the 3 classic ECG findings associated with WPW?
Short PR interval (<120ms)
Wide QRS w/ slurred delta wave
Secondary ST-T wave changes
What should unstable WPW patients be treated with?
Synchronized cardioversion
Patients with A fib + WPW + rapid ventricular response should be treated with what medications?
Amiodarone or Procainamide (to stabilize HR)
What is the long term treatment of symptomatic WPW?
Radiofrequency ablation
You should NOT use what type of agents alone for treatment of WPW?
- this will accentuate the accessory pathway and worsen the arrhythmia
AV nodal blocking agents (BBs, CCBs, adenosine, digoxin)
Which medications should NOT be used alone for treatment of WPW?
BBs, CCBs, Adenosine, Digoxin
Acute A fib:
New-onset A fib lasting <48 hours
Paroxysmal A fib:
Recurrent A fib that typically lasts <48 hours and converts spontaneously to normal sinus rhythm
Permanent A fib:
A fib with duration >7 days, unable to maintain sinus rhythym
Rapid ventricular response in atrial fibrillation is when the ventricular rate is greater than ____ BPM
100
TTE or TEE:
Evaluation of left atrial thrombus
TEE
TTE or TEE:
To guide cardioversion
TEE
TTE or TEE:
To evaluate pericardial disease
TTE
TTE or TEE:
To evaluate atrial and ventricular chamber/wall dimensions
TTE
TTE or TEE:
To evaluate for valvular heart disease
TTE
TTE or TEE:
To estimate ventricular function
TTE
TTE or TEE:
To estimate pulmonary systolic pressure (pulm HTN)
TTE
TTE or TEE:
Better for looking at the left side of the heart + more resolution
TEE
TTE or TEE:
2D doppler that can be done at bedside
TTE
What is the drug of choice for treatment of acute A fib for rate control?
IV Cardizem (Diltiazem)
We should be cautious with giving what drug in acute treatment of A fib, because it can cardiovert to NSR?
Amiodarone
How should a patient with acute stable A fib be treated?
HR control (Diltiazem)
How should a patient with acute unstable A fib be treated?
Cardioversion
What is the last option to treat A fib, and only used if the patient is also in heart failure?
Digoxin
If the patient has been in A fib for _____ hours, you can assume no clot is in the atrium.
<48
If the patient has been in A fib for >48 hours, what do we have to assume?
There is a clot
What must be done for treatment if the patient has been in A fib for >48 hours?
Get a TEE to prove there is no clot before cardioversion, OR min 3 months of anticoagulation
What must be done for treatment if the patient has been in A fib for <48 hours, but cannot be converted to NSR?
Anticoagulation
What is the CHA2DS2-VASc score used for?
To estimate risk of stroke in patients w/ A fib
What drug do you give for any valvular heart disease + A fib?
Warfarin
What is the recommended treatment for a CHA2DS2-VASc score of 0?
Low risk- no therapy is reasonable
What is the recommended treatment for a CHA2DS2-VASc score of 1?
Patient/provider decision- may do nothing, OR oral anticoagulation, OR ASA
What is the recommended treatment for a CHA2DS2-VASc score of >2?
High risk- DOAC or Warfarin recommended
(DOAC = direct oral anticoagulants)
How many CHA2DS2-VASc points:
CHF history
1
How many CHA2DS2-VASc points:
HTN (BP > 140/90)
1
How many CHA2DS2-VASc points:
Age >75 years
2
How many CHA2DS2-VASc points:
DM
1
How many CHA2DS2-VASc points:
Prior stroke/TIA/Thromboembolsim
2
How many CHA2DS2-VASc points:
Vascular disease
1
How many CHA2DS2-VASc points:
Age 65-74
1
How many CHA2DS2-VASc points:
Sex category (female)
1
What are the Direct Oral Anticoagulants (DOACs)?
Apixaban (Eliquis)
Dabigatran (Pradaxa)
Edoxaban (Savaysa)
Ribaroxaban (Xarelto)
DOACs are first line therapy for what condition?
A fib
Which drug has strongest evidence for chronic A fib with prosthetic mechanical heart valves?
Warfarin
What is the association between alcohol use and rhythm disturbances, particularly supraventricular arrhythmias in apparently healthy people?
Holiday heart syndrome
What is the most common rhythm disorder seen in Holiday Heart Syndrome?
A fib
What is the most common symptom of atrial flutter?
Palpitations
What does Atrial flutter show on an EKG?
Sawtooth pattern
Refractory cases of atrial flutter should undergo what procedure?
Ablation
What is a common arrhythmia that can be caused by alcohol, coffee, stimulants, and excitement?
SVT/PSVT
What is the rate for SVT/PSVT?
150-250 BPM
What is first line therapy for SVT/PSVT? Why?
Vagal maneuvers- kicks in the parasympathetic system to slow the rhythm
Which vagal maneuver is dangerous in older people?
Carotid massage
What is a vagal maneuver that should NOT be done if a bruit is heard or if the person is older?
Carotid massage
What is the pharmacologic agent that is 2nd line treatment for SVT/PSVT?
Adenosine (avoid in WPW/COPD/asthma)
What causes the R on T phenomenon?
When PVC occurs so early that it falls during the repolarization, which can result in V fib
What is the treatment for PVCs?
Empiric BBs
Torsades de pointes is associated with what on an EKG?
Prolonged QT interval (may be congenital or acquired)
In a young patient with Torsades, what should be considered?
Congenital long QT syndrome
What is the drug of choice for treatment of Torsades?
IV Mag sulfate
What is the most commonly identified arrhythmia in cardiac arrest patients?
Ventricular fibrillation
What is the treatment for ventricular fibrillation?
Immediate defibrillation
What kind of pulse will a patient in V fib have?
Pulseless
What arrhythmia is the cause of most sudden cardiac deaths?
VT or VF
What has a very fast ventricular rate that is usually dissociated from an underlying atrial rate?
V tach
How should a stable patient in V tach with a pulse be treated?
Amiodarone or Procainamide
How should an unstable patient in V tach with a pulse be treated?
Synchronized cardioversion
What is the treatment for a patient who is pulseless in V tach?
Defibrillation, CPR, Amiodarone, Epi
Ashman's phenomenon:
Aberrant ventricular conduction, usually of RBBB morphology, which follows a short R-R interval and preceding relatively prolonged R-R interval
What is often seen in A fib, but is clinically asymptomatic on its own?
Ashman's phenomenon
How should 2nd degree AV block Mobitz I be treated if the patient is symptomatic?
Atropine, Transcuatenous pacing
3rd degree AV blocks should be treated with what device?
Dual-chamber permanent pacemaker
Which class of antiarrhythmics:
Quinidine
1A
Which class of antiarrhythmics:
Procainamide
1A
Which class of antiarrhythmics:
Disopyramide
1A
Which class of antiarrhythmics:
Lidocaine
1B
Which class of antiarrhythmics:
Diphenylhydantoin (Phenytoin)
1B
Which class of antiarrhythmics:
Flecainide
1C
Which class of antiarrhythmics:
Propafenone
1C
Which class of antiarrhythmics:
Beta blockers
2
Which class of antiarrhythmics:
Amiodarone
3
Which class of antiarrhythmics:
Sotalol
3
Which class of antiarrhythmics:
Verapamil
4
Which class of antiarrhythmics:
Diltiazem
4
Which class of antiarrhythmics:
Adenosine
5
Which class of antiarrhythmics:
Digoxin
5
Which class of antiarrhythmics:
Block sodium channels
1A, 1B, 1C
Which class of antiarrhythmics:
Block potassium channels
3
What are some adverse effects of Quinidine?
Prolonged QT interval, Torsades
Which antiarrhythmic can cause Lupus like syndrome?
Procainamide
What is the primary use of Lidocaine as an antiarrhythmic?
Prevention of recurrent ventricular tachyarrhythmias
What is a common side effect of Tocainide?
Toxic CNS effects
Which class of antiarrhythmics:
Tocainide
1B
Which class of antiarrhythmics:
Mexilitine
1B
Note 
Flashcard (48)