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Apex Review > Cardiac rhythm monitors & equipment 4 > Flashcards

Cardiac rhythm monitors & equipment 4 Flashcards

1
Q

A patient with Wolff-Parkinson-White syndrome develops atrial fibrillation during surgery. Select the BEST treatment for this situation. (select 2)
a. cardioversion
b. verapamil
c. digoxin
d. procainamide

A

a. cardioversion
d. procainamide

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2
Q

Wolff-Parkinson White is the most common

A

pre-excitation syndrome

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3
Q

The defining feature of WPW consists of

A

an accessory conduction pathway (Kent’s bundle) that bypasses the AV node & the conduction delay associated with it

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4
Q

A key diagnostic feature of WPW on the EKG is

A

a delta wave

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5
Q

The most common tachydysrhythmia associated with WPW is

A

AV nodal reentry tachycardia

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6
Q

AV nodal reentry tachycardia can be classified as

A

orthodromic or antidromic

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7
Q

The most common AV nodal reentry tachycardia is

A

orthodromic

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8
Q

Orthodromic AV nodal reentry tachycardia is associated with

A

a narrow QRS complex

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9
Q

Treatment for orthodromic AV nodal reentry tachycardia includes

A

increasing the refractory period at the AV node (vagal maneuvers, amiodarone, adenosine, beta-blockers, verapamil, or cardioversion)

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10
Q

Antidromic AV nodal reentry tachycardia is associated with

A

a wide QRS complex

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11
Q

Treatment for antidromic AVNRT includes

A

increasing the refractory period of the accessory pathway (procainamide or cardioversion)

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12
Q

With antidromic AVNRT, these agents should be avoided:

A

agents that increase the refractory period of the AV node

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13
Q

Common characteristics observed on the EKG of a WPW include:

A

delta wave caused by ventricular preexcitation
short PR interval (<0.12 seconds)
wide QRS complex
possible T wave inversion

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14
Q

Drugs to avoid with antidromic AVNRT include

A

adenosine
digoxin
calcium channel blockers
beta-blockers
lidocaine

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15
Q

The combination of AF & WPW can precipitate

A

CHF, ventricular fibrillation, & death

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16
Q

Definitive treatment for WPW is

A

ablation of the accessory pathway

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17
Q

A complication of radiofrequency ablation of the left atrium is

A

thermal injury to the left atrium and esophagus
monitor esophageal temperature & let cardiologist know if it rises

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18
Q

Is orthodromic AVRNT or antidromic AVRNT more dangerous in the patient with atrial fibrillation? Why?

A

antidromic AVRNT- the AV node is bypassed and the ventricular rate can increase dramatically (up to 300 bpm) causing CHF and ventricular fibrillation

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19
Q

All of the following increase the likelihood of torsades de pointes in the patient with long QT syndrome EXCEPT:
a. hyperventilation
b. furosemide
c. methadone
d. metoprolol

A

d. metoprolol

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20
Q

Torsades de pointes is a

A

polymorphic ventricular tachycardia

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21
Q

Torsades de pointes is typically

A

self-limiting but it can deteriorate into ventricular fibrillation

22
Q

Torsades de pointes is usually associated with a

A

prolonged QT interval

23
Q

Conditions that prolong the QT interval include

A

hypokalemia
hypomagnesemia
methadone
droperidol
ondansetron
amiodarone
hypertrophic cardiomyopathy
bradycardia

24
Q

Acute treatment for torsades de points includes

A

magnesium sulfate & cardiac pacing

25
Q

What genetic syndrome can prolong QTc?

A

Romano-Ward Syndrome
Timothy syndrome

26
Q

The mnemonic for QTc prolongation is

A

POINTES

27
Q

POINTES stands for

A

phenothiazines
other meds
intracranial bleed
no known cause
type 1 antiarrhythmic drugs
electrolyte disturbances
syndromes

28
Q

A prolonged QT interval is defined as

A

> 0.45 seconds in men
0.47 seconds in women

29
Q

Prevention of torsades de points in patients with a long QT interval includes

A

patients with long QT syndrome may require beta-blocker prophylaxis and/or IC placement
avoid SNS stimulation

30
Q

All drugs that prolong the QTc interval include

A

methadone
droperidol
haloperidol
ondansetron
halogenated agents
amiodarone
quinidine

31
Q

What type of electrical stimulus can initiate torsades de pointes?

A

A PVC or poorly timed pacer discharge during the second half of the T wave (R on T phenomenon)

32
Q

Name 3 electrolyte disturbances that can prolong the QTc.

A

hypomagnesemia
hypokalemia
hypocalcemia

33
Q

A pacemaker consists of a

A

pulse generator & pacing leads that deliver electrical current to the heart

34
Q

Pacemakers are characterized by a

A

5 letter code

35
Q

Position 1 indicates

A

chamber paced

36
Q

Position 2 indicates

A

chamber sensed

37
Q

Position 3 indicates

A

response to sensed native cardiac activity

38
Q

Position 4 indicates

A

programability options

39
Q

Position 5 indicates

A

the pacemaker can pace multiple sites

40
Q

Common pacing modes include

A

asynchronous pacing
single-chamber pacing
dual-chamber pacing

41
Q

Failure to capture occurs when the

A

pacemaker delivers an electrical stimulus but fails to trigger myocardial depolarization

42
Q

Indications for pacemaker insertion include

A

symptomatic diseases of impulse formation
symptomatic disease of impulse conduction
long QT syndrome
dilated cardiomyopathy
hypertrophic obstructive cardiomyopathy

43
Q

The pneumonic for pacemakers is

A

PaSeR
chamber Paced
Chamber Sensed
Response

44
Q

O in the positions stands for

A

none

45
Q

Position 3 can have the following letters:

A

O= none
T= triggered
I= inhibited
D= dual (triggered & inhibited)

46
Q

Position 4 can have the following letters:

A

o= none
R= rate modulation

47
Q

Single-chamber demand pacing can be thought of as

A

a backup mode- it only fires when the native heart rate falls below a predetermine rate

48
Q

Asynchronous pacing delivers

A

a constant rate

49
Q

The most common mode of pacing is

A

dual-chamber AV sequential demand pacing - improves AV synchrony

50
Q

A patient undergoing a bunionectomy has a VOO pacemaker with a rate of 80 bpm. During the procedure, there is a failure to capture and the heart rate decreases to 50 beats per minute. Which of the following BEST explains why this complication occurred?
a. the EtCo2 was 20 mmHg
b. an ultrasonic harmonic scalpel was used
c. the patient was hyperthermic
d. the electrocautery setting was changed from “coagulation” to “cutting”

A

a. the EtCo2 was 20 mmHg

Apex Review (224 decks)

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