Cardiac rhythm monitors & equipment 4

Question 1

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

Answer 1

a. cardioversion
d. procainamide

Question 2

Wolff-Parkinson White is the most common

Answer 2

pre-excitation syndrome

Question 3

The defining feature of WPW consists of

Answer 3

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

Question 4

A key diagnostic feature of WPW on the EKG is

Answer 4

a delta wave

Question 5

The most common tachydysrhythmia associated with WPW is

Answer 5

AV nodal reentry tachycardia

Question 6

AV nodal reentry tachycardia can be classified as

Answer 6

orthodromic or antidromic

Question 7

The most common AV nodal reentry tachycardia is

Answer 7

orthodromic

Question 8

Orthodromic AV nodal reentry tachycardia is associated with

Answer 8

a narrow QRS complex

Question 9

Treatment for orthodromic AV nodal reentry tachycardia includes

Answer 9

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

Question 10

Antidromic AV nodal reentry tachycardia is associated with

Answer 10

a wide QRS complex

Question 11

Treatment for antidromic AVNRT includes

Answer 11

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

Question 12

With antidromic AVNRT, these agents should be avoided:

Answer 12

agents that increase the refractory period of the AV node

Question 13

Common characteristics observed on the EKG of a WPW include:

Answer 13

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

Question 14

Drugs to avoid with antidromic AVNRT include

Answer 14

adenosine
digoxin
calcium channel blockers
beta-blockers
lidocaine

Question 15

The combination of AF & WPW can precipitate

Answer 15

CHF, ventricular fibrillation, & death

Question 16

Definitive treatment for WPW is

Answer 16

ablation of the accessory pathway

Question 17

A complication of radiofrequency ablation of the left atrium is

Answer 17

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

Question 18

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

Answer 18

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

Question 19

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

Answer 19

d. metoprolol

Question 20

Torsades de pointes is a

Answer 20

polymorphic ventricular tachycardia

Question 21

Torsades de pointes is typically

Answer 21

self-limiting but it can deteriorate into ventricular fibrillation

Question 22

Torsades de pointes is usually associated with a

Answer 22

prolonged QT interval

Question 23

Conditions that prolong the QT interval include

Answer 23

hypokalemia
hypomagnesemia
methadone
droperidol
ondansetron
amiodarone
hypertrophic cardiomyopathy
bradycardia

Question 24

Acute treatment for torsades de points includes

Answer 24

magnesium sulfate & cardiac pacing

Question 25

What genetic syndrome can prolong QTc?

Answer 25

Romano-Ward Syndrome Timothy syndrome

Question 26

The mnemonic for QTc prolongation is

Answer 26

POINTES

Question 27

POINTES stands for

Answer 27

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

Question 28

A prolonged QT interval is defined as

Answer 28

>0.45 seconds in men >0.47 seconds in women

Question 29

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

Answer 29

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

Question 30

All drugs that prolong the QTc interval include

Answer 30

methadone droperidol haloperidol ondansetron halogenated agents amiodarone quinidine

Question 31

What type of electrical stimulus can initiate torsades de pointes?

Answer 31

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

Question 32

Name 3 electrolyte disturbances that can prolong the QTc.

Answer 32

hypomagnesemia hypokalemia hypocalcemia

Question 33

A pacemaker consists of a

Answer 33

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

Question 34

Pacemakers are characterized by a

Answer 34

5 letter code

Question 35

Position 1 indicates

Answer 35

chamber paced

Question 36

Position 2 indicates

Answer 36

chamber sensed

Question 37

Position 3 indicates

Answer 37

response to sensed native cardiac activity

Question 38

Position 4 indicates

Answer 38

programability options

Question 39

Position 5 indicates

Answer 39

the pacemaker can pace multiple sites

Question 40

Common pacing modes include

Answer 40

asynchronous pacing single-chamber pacing dual-chamber pacing

Question 41

Failure to capture occurs when the

Answer 41

pacemaker delivers an electrical stimulus but fails to trigger myocardial depolarization

Question 42

Indications for pacemaker insertion include

Answer 42

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

Question 43

The pneumonic for pacemakers is

Answer 43

PaSeR chamber Paced Chamber Sensed Response

Question 44

O in the positions stands for

Answer 44

none

Question 45

Position 3 can have the following letters:

Answer 45

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

Question 46

Position 4 can have the following letters:

Answer 46

o= none R= rate modulation

Question 47

Single-chamber demand pacing can be thought of as

Answer 47

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

Question 48

Asynchronous pacing delivers

Answer 48

a constant rate

Question 49

The most common mode of pacing is

Answer 49

dual-chamber AV sequential demand pacing - improves AV synchrony

Question 50

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"

Answer 50

a. the EtCo2 was 20 mmHg