Conduction Disorders

Question 1

What is the treatment for a patient in Sinus Bradycardia that is symptomatic or hemodynamically unstable?

Answer 1

Atropine

Question 2

Loss of Sinus “P” Wave for less than 2 seconds.

Answer 2

Sinus Pause

Question 3

Loss of Sinus “P” Wave for more than 2 seconds.

Answer 3

Sinus Arrest

Question 4

What medications can cause Sinus Arrest or Pause?

Answer 4

Digoxin
Beta Blockers
Verapamil
Diltiazem

Question 5

What is the treatment for Sinus Arrest or Pause?

Answer 5

Asymptomatic = None
Discontinue Offending Drug
Pacemaker if necessary

Question 6

What is Sick Sinus Syndrome known as?

Answer 6

Tachy-Brady Syndrome

Question 7

What is the treatment for Sick Sinus Syndrome?

Answer 7

Symptomatic = Permanent Pacemaker with Dual Chamber Pacing

Bradycardia + Ventricular Tach = Permanent Pacemaker with Implantable Cardioverter-Defibrillator

Question 8

What is the most common chronic Arrhythmia?

Answer 8

A-Fib

Question 9

What are some risk factors of A-Fib?

Answer 9

Cardiac Disease
Lung Disease
Hyperthyroidism

Question 10

A-Fib that terminates spontaneously or with intervention in < 7 days.

Answer 10

Paroxysmal A-Fib

Question 11

A-Fib that lasts for > 7 days.

Answer 11

Persistent A-Fib

Question 12

A-Fib that lasts longer than 12 months.

Answer 12

Longstanding Persistent A-Fib

Question 13

A-Fib that is jointly decided by both the patient and clinician not to treat.

Answer 13

Permanent A-Fib

Question 14

A-Fib in the absence of rheumatic mitral stenosis, mechanical or bioprosthetic heart valve, or mitral valve repair.

Answer 14

Nonvalvular A-Fib

Question 15

What is used to assess the risk of stroke in a patient with A-Fib?

Answer 15

CHA2DS2-VASc Risk Score

Question 16

What are the components of the:
CHA2DS2-VASc

Answer 16

CHF or LVEF < 40% = 1
Hypertension = 1
Age > 75 = 2
Diabetes = 1
Stroke/TIA = 2
Vascular Disease = 1
Age 65 - 74. = 1
Female = 1

Question 17

What CHA2DS2-VASc score would recommend oral anticoagulation?

Answer 17

> 2 in Men
3 in Women

Question 18

What CHA2DS2-VASc score would you consider oral anticoagulation?

Answer 18

1 in Men
2 in Women

Question 19

When should you admit a patient with A-Fib to the hospital?

Answer 19

Active Ischemia
Heart Failure
Hypotension
Difficult Rate Control
Confusion
Acute Renal Injury

Question 20

What is the first-line treatment for RHYTHM Control in a patient with onset and identifiable cause of A-Fib, or if the patients remains symptomatic despite rate control?

Answer 20

Cardioversion

Question 21

How is A-Fib treated in an unstable patient?

Answer 21

IV Heparin
IV Rate Control
- Calcium Channel Blocker or Beta Blocker
Cardioversion (120 - 200 J)

Question 22

What medication do you NOT give for rate control in patients with A-Fib + COPD

Answer 22

Beta Blockers

Question 23

What medication do you NOT give for rate control in patients with LV Dysfunction + Heart Failure

Answer 23

Calcium Channel Blockers

Question 24

What medications can be given to patients without Cardiovascular Disease to control A-Fib rate?

Answer 24

Beta Blocker
Diltiazem
Verapamil

Question 25

What is the drug of choice for A-Fib rhythm control?

Answer 25

Amiodarone

Question 26

What would be some indications for Rhythm Control (Cardioversion) instead of Long-Term Rate Control in A-Fib?

Answer 26

Hemodynamic Instability Failure of Rate Control First Episode Younger Patients (< 65) CHF Potentially Reversible Causes

Question 27

What are the Anticoagulants of choice for A-Fib stroke prophylaxis?

Answer 27

Warfarin Apixaban or Rivaroxaban Dabigatran

Question 28

Atrial Rhythm characterized by a rapid and regular atrial depolarizations with an atrial rate of 250 - 300.

Answer 28

A-Flutter

Question 29

A-Flutter is best seen in which leads?

Answer 29

Inferior Leads (II, III, avF)

Question 30

What is the preferred treatment for A-Flutter?

Answer 30

Catheter Ablation

Question 31

What are the two rhythms caused by Atrioventricular Re-Entrant Tachycardia (AVRT)

Answer 31

SVT Wolff-Parkinson-White

Question 32

Type of AVRT where the impulse travels down the normal AV node first and returns via the accessory pathway.

Answer 32

Orthodromic (95%)

Question 33

What kind of QRS complex results from Orthodromic AVRT?

Answer 33

Narrow QRS

Question 34

Type of AVRT where the impulse travels down the accessory pathway first and returns via the normal pathway.

Answer 34

Antidromic

Question 35

What kind of QRS complex results Antidromic AVRT?

Answer 35

Wide QRS

Question 36

SVT is most common among which population of patients?

Answer 36

Young Females

Question 37

How do you treat Stable SVT?

Answer 37

Vagal Maneuvers Adenosine

Question 38

How do you treat Unstable SVT?

Answer 38

Cardioversion

Question 39

What is the treatment for Wolff-Parkinson-White Syndrome?

Answer 39

Radiofrequency Ablation

Question 40

What medications can be used to treat Wolff-Parkinson-White?

Answer 40

Procainamide Ibutilide

Question 41

What medications should you avoid in patients with WPW?

Answer 41

Digoxin Beta Blockers Calcium Channel Blockers Adenosine

Question 42

What is the difference between Multifocal Atrial Tachycardia and Wandering Atrial Pacemaker?

Answer 42

MAT > 100 bpm WAP = 60 - 100

Question 43

Patients with Multifocal Atrial Tachycardia commonly have what?

Answer 43

Chronic Lung Disease

Question 44

What is the treatment for a First Degree AV Block?

Answer 44

No Treatment

Question 45

What is the treatment for a Second Degree Type 1 AV Block?

Answer 45

Asymptomatic = Nothing Symptomatic = Atropine or Epi

Question 46

What AV Block often progresses to a 3rd Degree?

Answer 46

Second Degree Type 2

Question 47

How do you treat a 2nd Degree Type 2 AV Block?

Answer 47

Atropine or Pacing Permanent Pacemaker if not resolved

Question 48

Type of AV Block where no atrial impulses reach the ventricles.

Answer 48

Third Degree AV Block (Atrial Rate > Ventricular Rate)

Question 49

What is the treatment for a 3rd Degree AV Block?

Answer 49

Temporary Pacing Permanent Pacemaker

Question 50

What type of QRS complex is seen with a bundle branch block?

Answer 50

Wide QRS

Question 51

What is the primary cause of V-Tach?

Answer 51

Coronary Artery Disease + Prior MI

Question 52

How long must V-Tach be to be considered sustained?

Answer 52

Longer than 30 seconds

Question 53

What rhythm can V-Tach progress to?

Answer 53

V-Fib

Question 54

What should all patients with Sustained V-Tach have?

Answer 54

Implantable Caridoverting Defibrillator

Question 55

How do you treat stable but symptomatic V-Tach?

Answer 55

Amiodarone

Question 56

How do you treat unstable V-Tach?

Answer 56

Cardioversion + Amiodarone

Question 57

What usually causes Torsades de Pointes?

Answer 57

QT Prolongation - ↓ Mg, K, or Ca

Question 58

How do you treat Torsades de Pointes?

Answer 58

Cardioversion Magnesium

Question 59

Fatally arrhythmia that usually begins as V-Tach and has a rate > 300

Answer 59

V-Fib