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Master the boards: Emergency Medicine > Cardiac Rhythm Disorders > Flashcards

Cardiac Rhythm Disorders Flashcards

(68 cards)

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1
Q

What can sudden loss of pulse be caused by?

A

Asystole
V-Fib
V-Tach
Pulseless electrical activity (PEA)

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2
Q

What is the best initial treatment in all forms of pulselessness?

A

CPR

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3
Q

In addition to CPR what is the treatment for Asystole?

A

Epinephrine: constricts vessels to shunt blood into central areas like the heart and brain

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4
Q

What is the best initial treatment for V-Fib?

A

Immediate, unsynchronized cardioversion(defibrillation) followed by resumption of CPR

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5
Q

After another attempt at Defibrillation in V-fib what do you do next?

A

Epinephrine + another shock

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6
Q

After Epi + shock in V-fib what is next?

A

Amiodarone (preferred) or lidocaine to try to get the next shock to be more successful
Mg

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7
Q

What is the cycle of treatment for V-Fib?

A

Shock, drug, shock, drug, shock, drug and CPR at all times between shocks

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8
Q

What are the only arrhytmias to get unsynchronized cardioverstion (Defibrillation)?

A

V-fib and V-tach

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9
Q

What is Ventricular Tachycardia?

A

Wide complex tachycardia with a regular rate

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10
Q

What determines the treatment of VT?

A

Hemodynamic status

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11
Q

How do you manage Pulseless VT?

A

Same management as VF: immediate defibrillation (Unsynchronized)

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12
Q

How do you manage hemodynamically stable VT?

A

Amiodarone then lidocaine then procainamide: if they fail then cardioversion

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13
Q

How do you manage hemodynamically unstable VT?

A

Electrical cardioversion several times then amiodarone, lidocaine, or procainamide

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14
Q

What is defined as hemodynamic Instability?

A

Chest Pain
Dyspnea/CHF
Hypotension
Confusion

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15
Q

What is PEA?

A

Heart is electrically normal but there is no motor contraction: heart may be contracting without meaningful CO

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16
Q

How do you treat PEA?

A

Correct underlying cause

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17
Q

What are common causes of PEA?

A

Tamponade
Tension Pneumothorax
Hypovolemia and Hypolglycemia
Massive PE
Hypoxia, Hypothermia, Metabolic acidosis
High or low K

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18
Q

What symptoms are suggestive of Atrial arrhythmias?

A

Palpitations, Dizziness, Lightheadedness
Exercise intolerance or dyspnea
Embolic stroke

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19
Q

What are the underlying causes of A-Fib and A-Flutter?

A

Anatomic abnormalities of the atria from HTN or valvular heart disease

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20
Q

How does the rhythm present in A-Fib?

A

Irregular rhythm

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21
Q

Does does the rhythm present in A-Flutter?

A

Regular Rhythm

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22
Q

What causes Palpitation but not A-fib?

A

caffeine

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23
Q

What is the standard of care for A-Fib?

A

rate control and anticoagulation

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24
Q

How do you manage Hemodynamically unstable Atrial arrhytmias?

A

Synchronized caridioversion: prevents shock during the refractory period (ST-T wave)

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25
What is the best treatment approach in Chronic A-Fib lasting >2 days?
Slow the rate then anticoagulate
26
What is the best initial thearpy for Fibrillation of Flutter?
Rate control with Beta-blockers, Calcium channel blockers or digoxin
27
Once rate is controlled to <100 in fibrillation or flutter what do you give?
DOAC Warfarin for metal valves or MS
28
What are common DOAC agents?
Dabigatran Rivaroxaban Edoxaban Apixaban
29
What INR is maintained with warfarin use?
2-3
30
What CCBs can be used to control heart rate with atrial arrhytmias?
Diltiazem and Verapamil: they reliably block the AV Node
31
How do you calculate stroke risk in A-FIB?
CHADS-VASc score
32
What CHAD-VASc score does not require anticoagulation?
1 or less
33
What CHAD-VASc score requires anticoagulation?
2 or more with DOAC or Warfarin
34
What are the point values in the CHAD-VASc score?
CHF or Cardiomegaly = 1 Hypertension = 1 Age > 75 = 2 Diabetes = 1 Stroke or TIA = 2 Vascular disease = 1 Age 65-74 = 1 Sex (Female) = 1
35
What is the reversal agent for Factor Xa inhibitors?
Andexanet alfa
36
What agents does Andexanet alfa reverse?
Factor Xa inhibitors
37
What is the reversal agent for Dabigatran?
Idarucizumab
38
What agent does Idarucizumab reverse?
Dabigatran
39
What is the reversal agent for warfarin?
Prothrombin Complex Concentrate (PCC)
40
What agent does PCC reverse?
Warfarin
41
How does SVT present?
Palpitations in a patient who is hemodynamically stable
42
What is the best initial treatment for SVT?
Vagal Maneuvers If no response to maneuvers: Adenosine if no response to adenosine: BB (metoprolol), CCB (Diltiazem) or digoxin
43
What is first line therapy for SVT?
Vagal Maneuvers
44
What is 2nd line for SVT if Vagal Maneuvers do not work?
Adenosine
45
What is 3rd line for SVT if Adenosine does not work?
Beta-Blockers (metoprolol), Calcium channel blockers (diltiazem) or digoxin
46
What is Wolff-Parkinson-White Syndrome (WPW)?
Anatomic abnormality in the cardiac conduction pathway
47
How to answer WPW as the most likely diagnosis?
SVT alternating with V-tach SVT that gets worse after Diltiazem or Digoxin Delta wave on EKG
48
What drugs worsen the arrhythmia in WPW?
Diltiazem and Digoxin
49
What is the characteristic EKG finding in WPW?
SVT alternating with V-tach and Delta waves
50
What is the most accurate test for WPW?
Electrophysiology (EP) study
51
How do you treat acute WPW?
Procainamide, Ibutilide or amiodarone
52
How do you treat chronic WPW?
Radiofrequency catheter ablation (Curative)
53
What drugs are dangerous in WPW and why?
Digoxin and CCBs: they block the normal AV node and force conduction into the abnormal pathway
54
What is Multifocal Atrial Tachycardia (MAT) associated with?
chronic lung disease such as COPD
55
How do you treat Multifocal atrial tachycardia (MAT)?
treat the underlying lung disease Rate/Rhythm control anticoagulate but avoid beta-blockers
56
What drug do you want to avoid in Multifocal Atrial Tachycardia (MAT)?
Beta-Blockers due to underlying lung disease
57
How do you manage Premature Atrial Complexes (PAC) and Premature ventricular Complexes (PVC)?
no specific therapy no matter how many of them there are
58
How do you treat asymptomatic sinus bradycardia?
No treatment no matter how low the HR
59
What is the best initial therapy for Symptomatic bradycardia?
Atropine
60
What is the most effective therapy for Symptomatic bradycardia?
Pacemaker
61
What are the treatment options for First degree AV block?
None, Atropine or pacemaker
62
What is Second degree Mobitz I AV Block (Wenckebach)?
Progressively lengthening PR interval resulting in a dropped beat
63
What causes Second degree Mobitz I AV Block (Wenckebach)?
Most often due to normal aging of the conduction system
64
How do you treat Second degree Mobitz I AV Block (Wenckebach)?
No treatment if asymptomatic, pacemaker
65
What is Second degree Mobitz II AV Block?
Dropped beat without the progressive lengthening of the PR interval
66
What does Second degree Mobitz II AV Block progress or deteriorate into?
3rd degree AV block: complete heart block
67
How do you treat Second degree Mobitz II AV Block?
Pacemaker even if asymptomatic
68
How do you treat Third Degree AV Block (complete heart block)?
Pacemaker

Master the boards: Emergency Medicine (8 decks)

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