cardiology

Question 1

SVT
pharm management step up
first second third last measure pharm fails

Answer 1

1. adenosine
2. ca channel blocker
3. digoxin or IV metoprolol

all fail flip dc cardioversion

Question 2

SVT
prevention pharm treatment
failure of pharm to prevent next step

Answer 2

1. ca channel blocker

2. symptomatic or recurrent radiofrequency catheter ablation

Question 3

SVT

mechanism of treatment physical and pharm

Answer 3

stimulate vagus delay AV node rentry physical

pharm treatment delay av node rentry

Question 4

wolf parkinson syndrome (WPS)

1. acute management + mechanism
2. contraindicated drugs and pathophysio
3. chronic management

Answer 4

1. amiodaron (class 3 antiarrythmic) and procaimide class 1 antiarrythmic block k+ channels prolong repol –> prolonging qt. increase time till ventricular depol
2. digoxin and CCB c/I b.c block av node / regular pathway increase accessory pathway make arrhythmia worse
3. chronic radiofrequency catheter ablation curative

Question 5

WPS

signs an symptoms

Answer 5

delta wave
short pr interval 
wide qrs b.c of delta wave
worsening with digoxin or CCB goes into ventricular tachycardia 
SVT alternating with VT

Question 6

SVT unstable MNGT

Answer 6

cardioversion

Question 7

Atrial fibrillation MNGT

Answer 7

1. rate control (before cardioversion) 60-100 target
2. anticoagulation 3 weeks ( if necessary)
3. cardioversion

Question 8

atrial fibrillation anticoagulation

1. indication
2. reasoning for treatment
3. method of treatment
4. INR goal range

Answer 8

1. > 48 hours onset Afib or onset unknown
2. prevention of embolization during cardioversion high risk prevent cerebovascular accident
3. 3 weeks before cardioversion and 4 weeks after cardioversion
4. INR 2-3

Question 9

atrial fibrillation anticoagulation risk assessment

Answer 9

risk assessment
c- congestive heart failure or CAD-1
h- hypertension -1
a- >75 years-1
d- DM-1
s-stroke-2

Question 10

Anticoagulation drug TX indication per chad score

Answer 10

<1 - aspirin alon
< or equal 2 –> warfarin, dabigatran, xa inhibitors
no bridging

Question 11

Afib anticoagulation warfarin indication

c/I to warfarin use in AFIb

Answer 11

indications 
1. metal valve must bridge
2. valve disease (mitral stenosis) must bridge
C/I Major bleed
1. intracranial hemorrhage 
2. bleeding requiring transfusion

Question 12

Afib immediate synchronized cardioversion indication

Answer 12

1.unstable hemodynamically
hypotension 
confusion 
worsening symptoms 
CHF
chest pain
2.<48 hours
3. first ever Afib

Question 13

Afib rate control drugs and special dictions

Answer 13

1. beta blocker - ex grave disease
2. ca blocker - asthma, migraine
3. digoxin or amiodarone - LV dysfunction, hypotension
   rhythm control

Question 14

Afib when is pharm conversion indicated

list drugs used

Answer 14

when electrical cardioversion fails or is not
feasible: Parenteral ibutilide, procainamide, flecainide, sotalol, or amiodarone
are choices.

Question 15

multifocal atrial tachycardia MNGT

Answer 15

treat underlying disease -copd
oxygenation- 
CCB drug of choice 
BB C/I b.c possible bronchoconstricts
digoxin - LV non function

Question 16

sick sinus rhythm treatment

Answer 16

venous pacemaker

Question 17

PAC and PVC indication for treatment and drug used to treat

Answer 17

Both -Treat if patient is symptomatic

both - treat w BB

Question 18

1. Patient diagnosed with PVC next step

2. who benefits form ICD

Answer 18

1.work up for underlying heart disease

2.patient with underlying structural Heart disease have increase risk Vfib - sudden cardiac death
work up patient with electrophysiology
benefit from ICD

Question 19

Vfibrillation /pluseless Ventricular Tachycardia - management

Answer 19

< less than 5 minutes immediate unsychronized defibrillation/ DC cardioversion 3 times

> 5 minutes or unwitnessed - start cpr 2 minutes then check pulse, rhythm shock if necessary. give epinephrine during cpr 1mg and there after every 3-5 min
then defibrillate give 3 shocks
on 3rd shock if no change give amiodarion 300 mg iv with epinpephrine continue

Question 20

Ventricular Fibrillation management after successful

cardioversion

Answer 20

continue IV amiodarone drip

implantable defibrillator

Question 21

Torsades de point MNGT

Answer 21

mg+ sulfate

Question 22

Brugda syndrom

Answer 22

ICD

Question 23

VT with pulse management

1. unstable VT w pulse
2. stable VT w puls

Answer 23

1. unstable w pulse immediate synchronous cardioversion and follow with amiodarone
2. sable with pulse -

Question 24

1. define Nonsustained VT

Answer 24

1.Brief, self-limited runs of VT, Usually asymptomatic

Question 25

1. sustained VT define | 2.

Answer 25

Sustained VT (persists in the absence of intervention) • Lasts longer than 30 seconds and is almost always symptomatic • Often associated with marked hemodynamic compromise (i.e., hypotension) and/or development of myocardial ischemia • A life-threatening arrhythmia • Can progress to VFib if untreated

Question 26

VT prognosis

Answer 26

good- if no underlying heart disease | poor - after MI

Question 27

Sustained VT MNGT 1. stable 2. unstable stable 3. long term treatment

Answer 27

1. Hemodynamically stable patients with mild symptoms and systolic BP > 90 —pharmacologic therapy • IV amiodarone drug of choice*** ,or IV procainamide, or IV sotalol (over IV lidocaine) 2. Hemodynamically unstable patients or patients with severe symptoms • - Immediate synchronous DC cardioversion - Follow with IV amiodarone to maintain sinus 3. Ideally, all patients with sustained VT should undergo placement of an ICD, unless EF is normal (then consider amiodarone).

Question 28

Sustained VT MNGT 1. asymptomatic or no underlying heart disease 2. HX of MI, LV dysfunction, symptomatic, or heart disease 3. second line treatment

Answer 28

1. If no underlying heart disease and asymptomatic, do not treat. These patients are not at increased risk of sudden death. 2. If the patient has underlying heart disease, a recent MI, evidence of left ven- tricular dysfunction, or is symptomatic, order an electrophysiologic study: If it shows inducible, sustained VT, ICD placement is appropriate. 3. Pharmacologic therapy is second-line treatment. However, amiodarone has the best results of all of the antiarrhythmic agents.

Question 29

2nd degree AV block type II MNGT | 3 degree AV block

Answer 29

transvenous pacemaker - no atropine C/I

Question 30

first degree AV block 2nd degree Av block sinus Bradycardia

Answer 30

atropine | beign conditions

Question 31

Sites of block | 1,2 degree type I and II degree heart block

Answer 31

first degree and 2nd degree type I --> located AV node | 2nd degree type II- located in his purkinjie fibres

Question 32

1. PEA/asystole | 2. define PEA

Answer 32

non shockable rhythm cpr for 2 min or 5 rounds and epinephrine every 2-3 minutes 2. Any rythmn on ECG without a pulse