Congenital Heart Disease Flashcards
(183 cards)
1
Q
Name the presenting sings of Heart Disease in Neonates (5)
A
- Cyanosis
- Shock
- Congestive Heart Failure
- Murmurs
- Arrhythmias
2
Q
What fraction of Cyanotic CHD are found on U/S?
A
2/3
3
Q
Name the clues to Cyanotic CHD
A
- Cyanosis w/normal lung exam, without RDS PCO2 is normal or low (w/compensation) but low SpO2’s
- Unresponsive to Oxygen (PO2 <150 on 100% FiO2)
- Murmurs (often present)
- Abnormal heart on CXR
4
Q
What is the best site for a blood gas to evaluate for Cyanotic CHD?
A
Right wrist–Preductal
5
Q
What are high-risk situations of Cyanotic CHD? hint-same as for any CHD at all
A
Chromosomal abnormalities
Multiple congenital anomalies
IDM’s
Family Hx of CHD
6
Q
What is the % of CHD if a sibling has CHD?
A
3-4%
7
Q
What is the % of CHD if a parent has CHD?
A
5-10%
8
Q
What Cyanotic CHD is it?
An x-ray describes: Cardiothoracic ratio >0.6 Large, Boot-shaped heart, Apex tipped up Decreased lung vascularity Missing main pulmonary artery marking
A
Tetrology of Fallot
9
Q
Where does the least oxygenated blood flow back to the heart from?
A
Head
10
Q
What is often the first clue of a cyanotic CHD?
Is it responsive to giving O2?
Why or why not?
A
Cyanotic baby w/low SpO2’s
No
Some of the blue blood going back to the body is going out through the Aorta. Nothing you do to the lungs will help this.
11
Q
Can you have absolutely normal PO2’s with Cyanotic CHD?
A
No
12
Q
Is saturation a sensitive measure?
Why or why not?
A
No
W/Hgb F can have PO2 of 50 and Saturations high 90’s.
13
Q
In lecture what PO2 level is used to determine a cyanotic lesion?
What can it depend on?
A
Can’t get PO2 >150 Torr (not perfect system)
Depends on degree of pulmonary blood flow
14
Q
Can you get a venous stick to get a blood gas to detect cyanotic heart dz?
A
No, Must be Arterial (preferably right wrist)
15
Q
Is a murmur definitive of cyanotic heart Dz?
A
No, not all w/Cyanotic CHD have murmurs and not all w/murmurs have Cyanotic CHD
16
Q
In a TOF heart, why is the apex tipped up on CXR?
A
There’s a thick R heart and the Diaphragmatic surface of the heart is the R Ventricle
17
Q
What diagnostic test can pick up CHD better than in-utero U/S?
A
Fetal Echocardiogram
18
Q
Describe Fetal circulation starting with oxygenated blood from the placenta.
A
Placenta–>Umb. Vein–>Ductus Venosus & IVC–>R. Atrium (via FO)–>L. Atrium–>Mitral Valve–>L. Ventricle–>Aortic Artery–>Aortic Arch to head/coronary A’s or Descending Aorta to body–>Deox. blood from head via SVC–>R. Atrium–>Tri valve–>R. Ventricle–>Pulmonary Artery–>(almost all through) Ductus Arteriosis–>lower body via Descending aorta–>most to placenta via Umb. Arteries
19
Q
What 2 organs require the most oxygeated blood in-Utero and post-natally?
Where does it come from?
A
- Coronary Arteries
- Head
Supplied by blood from LV/Aortic Artery
20
Q
How much oxygenated blood flows across the Aortic Isthmus down the descending Aorta?
A
~10%
21
Q
Where is the least oxygenated blood in the fetus?
A
That coming back from the upper body–it extracts the most oxygen.
22
Q
What is his rudimentary definition of Cyanotic CHD?
A
Blue blood somehow comes from the Vena Cava through the Aorta & Red blood comes back (in the absence of lung dz, normal pulmonary venous saturation-close to 100%)
23
Q
Why don’t you get much effect from supplemental oxygen in babies w/cyantoic CHD?
A
The cyanotic blood is going to the systemic circulation, not pulmonary–so in the absence of lung dz, extra O2 won’t affect their cyanosis.
24
Q
In order for blue blood o get out to the Aorta, there needs to be what?
Is this sufficient to create cyanotic CHD?
A
A site of mixing
No–depends on the flow-most L–>R shunts don’t create cyanosis
25
What is required for Cyanotic CHD?
Something that makes it hard for systemic venous blood to go to the lungs
- Rt side obstruction
- Unfavorable streaming
- Complete mixing with decreased pulmonary flow
26
What is the ultimate condition of Unfavorable streaming of blood?
Transposition of the Great Vessels/Arteries
27
Name the Right-sided obstructive lesions (5).
1. Tricuspid Atresia
2. Ebstein's Anomaly
3. Tetrology of Fallot
4. Pulmonary Atresia
5. Pulmonic Stenosis w/Atrial shunting
28
Name the 3 complete mixing lesions w/decreased pulmonary blood flow.
1. Atresia of any valve
2. Single ventricle
3. TAPVR
29
What does Atresia mean?
Complete absence of a connection
30
True/False:
| Babies are designed to allow R-->L shunting?
True, via FO
31
With Tricuspid Atresia, all PULMONARY blood must cross either of what 2 things?
VSD
| PDA
32
What is the tx for babies w/Tricuspid Atresia?
Palliation
| Treated like a single ventricle defect, can't fix it.
33
With Tricuspid Atresia with PDA, there will be more/less blood going out to the lungs?
Would baby be more/less symptomatic w/PDA?
More
Less
34
Obstruction at the Tricuspid valve makes it easier/more difficult for blue blood to get to the lungs?
More Difficult
35
Ebstein's Anomaly causes the blood to do what at the Tricuspid valve?
Leak
36
What is Ebstein's anomaly?
Anomaly of the Tricuspid valve. It fails to delaminate from the RV endocardium.
37
Ebstein's is a/w _______ regurgitation & ____ sided Atrial enlargement
Tricuspid
| Right
38
What type of shunt is there w/Ebstein's?
Right-->Left Atrial
39
Tricuspid regurgitation may do what to forward flow of blood?
Impair forward flow
40
True/False: w/Ebstein's there's "Atrialized" Right ventricular tissue?
True
41
True/False: TOF is a very common form of cyanotic heart disease?
True
42
TOF is mixing at what level?
Why?
Mixing at the Ventricular level
Wall between Lt & Rt Ventricular outflow tract is underdeveloped and it get's pulled over to the Rt
43
TOF consists of 4 things, what are they?
1. Obstruction of the pulmonary outflow tract
2. Over-riding Aorta
3. VSD
4. R.V. hypertrophy
44
True/False: w/TOF, there can be several levels of obstruction of blood flow to lungs?
True
45
True/False: With many types of Cyanotic heart disease, Opening the Ductus Arteriosus is a good thing to do, even when you don't know what the cause is.
How?
True
Prostaglandins, PGE1
46
Pulmonary Atresia w/Intact Ventricular Septum is a mild/extreme form of TOF.
True, but it can also be w/o an intact ventricular septum
47
What are the only 2 places blood can go once in the Rt Ventricle with Pulmonary Atresia with intact Ventricular Septum?
What can sometimes happen w/this D/O?
Backward across the Tricuspid valve or backward flow in to the veins that normally drain from coronary arteries to RV (coronary sinusoids)
MI (d/t lack of blood flow to septum of the heart)
48
In Pulmonary Atresia w/Intact V Septum, all systemic venous flow must cross what?
Pulmonary blood flow arises mainly from?
Eventually will need what done?
If they can have a Balloon Pulmonary Valvuloplasty, this allows what?
Atrial Septal Defect
```
Ductus Arteriosus (sometimes will stent it open)
Single ventricle palliation, Blallock-Taussig shunt
```
Right ventricle to develop normally
49
What is Critical Pulmonic Stenosis?
If Pulmonic stenosis is only mild, what might you have?
What kind of shunt?
Is often responsive to what?
Obstruction to pulmonary outflow at pulmonary valve
Only a murmur
R-->L across PFO
Balloon Valvuloplasty
50
There are 2 parallel circuit circulations in what anomaly?
Transposition of the Great Arteries
51
With transposition of the great arteries, you must have what?
Some form of communication (many are Atrial) but also need a PDA; otherwise they die
**must have a way to get blue and red blood to mix
52
With transposition, to get mixing you must have what kind of flow?
Is this an efficient form of blood flow?
Bi-directional flow
No
53
If you have to have a single site of mixing, which site is better, Atria (PFO) or Ductus Arteriosus?
Atrial shunt (PFO)
54
If a baby needs a PFO to allow mixing, what is the name of the procedure used to create it?
Balloon Atrial Septostomy
55
What 3 things determine the Arterial oxygen Saturation (SaO2)?
1. How blue is the blue blood? (systemic venous saturation)
2. How red is the red blood? (pulmonary venous saturation)
3. How much is mixed?
56
In a complete mixing lesion with more Pulmonic flow versus Systemic flow there would be a higher/lower SaO2?
Lower
57
In a complete mixing lesion with more Systemic versus Pulmonic flow, there would be higher/lower SaO2?
Higher
58
With a complete mixing lesion and opening the ductus, you may see a baby go from profound cyanosis to no visual cyanosis.
True
59
If you have a lesion with unfavorable streaming (from TGA) or Rt-sided obstructive lesion, what will help the pulmonary flow of the baby?
Open the DA
60
What happens to the pulmonary venous connection with TAPVR?
The Pulmonary veins that should come back to the L Atrium, did not form that connection.
61
What happens to circulation in TAPVR?
Persistent fetal circulation (fetal connections of pulmonary veins to SVC or IVC persist).
62
There are 2 forms of TAPVR what are they? Which one is a surgical emergency?
```
Supracardiac TAPVR
Infracardiac TAPVR (this one is emergent d/t flow of blood-can't get blood into or out of the lungs)
```
63
Supracardiac TAPVR is classified as what type of lesion?
Nearly complete mixing lesion. All blue and red blood comes back to R. Atrium
64
True/False, with supracardiac TAPVR, the only blood to the L. Atria is that from the R.A. across the PFO.
True
65
With what 2 cardiac lesions is it possible to have post-ductal saturations higher than pre-ductal?
Supracardiac TAPVR
| Transposition of the Great Arteries
66
With Supracardiac TAPVR, most of the red blood travels where?
Most of the blue blood travels where?
If there's a PDA, some of the red blood can travel where creating possibility of higher post-ductal saturations than pre-ductal?
SVC-->R.A.-->tricuspid valve-->R.V.
IVC-->R.A.-->PFO-->L.V.
To the descending Aorta
67
With TAPVR if the pulmonary veins are obstructed, there's what?
If the pulmonary veins are unobstructed, there's what?
```
Pulmonary Edema (lungs white-out)
Decreased Pulmonary flow
```
Increased Pulmonary flow
Little Cyanosis
Congestive Heart Failure
68
True/False: In Infracardiac TAPVR is almost always a complete mixing lesion.
True, surgical emergency
69
In Tricuspid Atresia, when the DA closes, what happens?
What procedure can be done to help this baby?
```
Increased cyanosis
(Less blood flow to lungs = less red blood to body)
```
Blalock-Taussig shunt (subclavian artery to pulmonary artery shunt to get some blood to lungs)
70
What shunt was the first one done to help babies w/CCHD?
Blalock-Taussig shunt
| subclavian artery to pulm artery
71
True/False: We have good treatments for almost all forms of CHD.
What are some exceptions?
How long can single ventricle palliations last?
True
Single ventricle anomalies (no way to make a ventricle) i.e. Tricuspid Atresia
Decades
72
What is the goal of blood flow w/single ventricle anomaly?
Could you put in a Blalock-Taussig shunt at birth?
Why?
Get the venous return to go directly to the lungs.
No (can do bi-directional Glenn at 4 mos)
PVR is very high just after birth
73
What happens w/Bi-Directional Glenn?
1. Blalock-Taussig shunt is disected.
2. SVC is connected directly to Rt. Pulmonary artery (passive flow)
3. Ligation, Dissection, or Banding of Pulmonary Artery off R.Ventricle
74
Can a Fontan procedure be done right away?
No, at age 2-3 y/o that creates a conduit from IVC to SVC (allows blue blood from IVC out directly to lungs)
75
What is a Fontan?
A connection done at 2-3 y/o
76
If you only have 1 ventricle, the goal of that blood flow is what?
Get blood to the systemic circulation
| a connection can be surgically made to get blood to the lungs
77
What can be done for complete repair of TOF?
1. Resection of valvular pulmonic stenosis area (no valve)
2. Patch closure of VSD
3. Patch augmentation of RV outflow tract (Pulm Artery)
78
What may be needed later in life in someone who has had a complete TOF repair?
A Pulmonary valve replacement
79
What were the first operations done for TGA?
Mustard or Senning operation
| baffling blue blood inside the R. atrium and directed it to L. A. toward mitral valve-->lungs
80
What is the down-side of the Mustard or Senning operation?
R.V. has to do L.V. pumping workload
| but people can live into 30's with these procedures
81
What is the current option for TGA?
When is this done?
Down side of this procedure?
Arterial Switch procedure (w/closure of ASD/VSD if present)
Done at ~ 1 wk of age
Have to move the coronary arteries
82
What is shock?
Inadequate Systemic Perfusion
83
What is a late sign of shock?
Hypotension
84
True/False: Hypertension can be seen early in shock.
True
85
Shock can be difficult to detect, what is the best tool to recognize it?
Experienced bedside RN
86
What types of neonatal Heart dz can present with Shock?
```
Left-sided Obstructive lesions
Sustained Tachycardia (SVT or Ventricular)
Profound Bradycardia
```
87
Name Left-sided obstructive lesions
Coarctation, Critical Aortic Stenosis, Hypoplastic Left Heart Syndrome
88
Is shock instantaneous w/SVT?
No, ~48 hrs
89
With Left-sided obstructive lesions is the baby blue?
Will they have low saturations?
How do you know they have perfusion issues?
No
No
Low U.O. (low CO), Cap refill, Periph pulses
90
The CCHD test is designed to detect what lesion?
Is it perfect?
Coarctation of the Aorta
No
91
Where does Coarctation occur usually?
Adjacent to the Ductus (Juxtaductal)
92
Are babies w/Coarctation usually ok in the normal nursery?
Yes (due to Ductus)
93
When the ductus closes, which side closes first?
The Pulmonary Artery end
| functional closure--first 24-48 hrs
94
When do babies w/Coarctation get into "trouble"?
Why?
Couple weeks of age
PDA finishes closing on Aortic Arterial side (Anatomic closure) and it becomes more difficult for the blood to get around the Coarct "shelf" ( the little diverticulum into the aorta)
95
What happens to blood flow with coarctation?
Less flow to descending Aorta-->Very high Afterload-->Decreases C.O.-->L. Ventricle can't squeeze well-->Increased pressure on L. Atrium-->Pulmonary Edema & Decreased Perfusion to lower part of body (low U.O., increased edema, Renal failure)
96
Think about what lesion in every baby?
Do what at every opportunity?
Coarctation
Feel the Femoral vs. Brachial pulses
97
Do what if a baby comes back in w/Jaundice, Sepsis, Feeding difficulties?
Feel the Femoral Pulses, R/O Coarctation. It can be tough to pick up.
98
Are there good results from tx/repair of Coarctation?
Yes, very good results
99
With any baby in Shock, Assume they have what until proven otherwise?
Coarctation of the Aorta
| -Many more babies die of Coarctation than Septic Shock
100
True/False: with Coarctation, there's always a discrepancy of b/p from upper to lower extremities.
False, this time is fleeting
L.V. just can't pump very well and eventually just have bad pulses everywhere
101
True/False: You can use the DA to maintain either Pulmonary or Aortic blood flow.
True. It can be used w/Coarct
102
What would you do 1st in baby w/Coartation?
What would you do 2nd?
Intubate (take away their WOB)
Start PGE ASAP
103
With Critical Aortic Stenosis are the saturations typcially normal?
How is this tx'd?
No
Is Ductal dependent, likely fail CCHD
PGE, balloon or surgical valvotomy, Norwood
104
Which babies likely fail CCHD?
Critical Aortic Stenosis
105
Hypoplastic Left Heart Syndrome is really the extreme form of?
Aortic Stenosis
106
What is often present with HLHS?
Aortic Atresia or Stenosis
| Mitral Atresia or Stenosis
107
Which side is dependent upon to be the pumping chamber of the heart for the body with HLHS?
The Right Ventricle
108
Do babies w/HLHS have pulmonary edema?
Decreased systemic flow?
Are they ducal dependent?
Yes
Yes
Yes
109
Are most HLHS diagnosed prenatally?
Yes, most of the time.
110
What tx is there for HLHS?
PGE
Norwood
Transplant
Comfort Care
111
True/False: when the DA closes in a baby with HLHS, there will be increased pulmonary edema.
True
112
Babies w/HLHS are typically what color.
Why?
Grey (not blue)
D/t low C.O.
113
Why is a PDA necessary w/HLHS?
Depending blood flow from Ductus through Aorta for systemic blood flow ---O2 sats may actually increase w/open DA
114
In what cardiac lesion do you need to be very judicious with O2 use?
Why?
HLHS
O2 is a very potent pulmonary vasodilator--> easier for blood to go to lungs-->R.V. may not be able to increase the output enough
115
What is the ratio aim for Pulmonary to Systemic blood flow in a baby with a complete mixing lesion?
1:1
116
If you have a baby w/HLHS with saturations in the 90's, is this good or bad?
What is the cause?
Bad, want 75-85%
It is caused by increased pulmonary blood flow.
117
The tx of HLHS is to create a reliable connection from R.V. to the Aorta by first the Norwood, then the Glenn, lastly the Fontan. What is the Norwood Procedure?
Norwood Procedure:
1. Anastamose proximal Pulmonary Artery to Ascending Aorta
2. Enlarge Aortic Arch, dissect ductal tissue
3. Shunt from Aorta to Distal Pulmonary Artery
4. Enlarge ASD
5. Mixing with controlled pulmonary flow
118
With HLHS when going from Norwood to Glenn, what does this do?
Creates bi-directional flow (connects SVC to Pulm Artery, & they get rid of Arterial shunt)
119
With HLHS what does the ultimate Fontan procedure do?
Allows the blue blood from the lower extremities go directly to the lungs
120
What is CHF?
Failure of the Heart to Pump Adequately
121
Some of the signs of CHF overlap with what signs? Plus?
Signs of Shock
+Sweating w/feeds
Enlarged Liver
Increased Respiratory Effort
122
What lesions can cause CHF?
Large L-->R shunts (ASD, VSD, Truncus, Single Ventricle w/o Pulmonary Stenosis)
Left-Sided obstructive lesions
Cardiomyopathy
Longstanding Tachycardia/Bradycardia
123
With a small VSD you will hear?
Harsh, High-Pitched Holosystolic Murmur
124
Will you always hear a murmur with a Large VSD?
Why?
No
Less Turbulence
125
With a VSD, Is it typical to have signs of CHF before 6 wks?
Why/why not?
No
see when PVR falls
126
Would you be more likely to have CHF with a large or small VSD?
Large
127
With VSD, A Diastolic Rumble heard at the Apex is better heard with Bell or Diaphragm?
Caused from?
Bell--easiest to hear when you press down first, then let up on the pressure
Turbulence across Mitral valve
128
Do muscular VSD's get smaller?
Yes
129
What is an Atriovetricular Septal Defect?
A hole in the middle of the heart/septum both Atrially and Vetricularly
130
What babies have increased relative risk of Atrioventricular Septal Defects?
Babies w/Down Syndrome
131
With Atrioventricular Septal Defect, what kind of shunt do they have L-R or R-L?
L-->R
132
About how many babies w/Down Syndrome have CHD?
In Down Syndrome is AVSD more or less common than VSD?
50%
Less
133
Is Truncus Arteriosus a Cyanotic Lesion?
No, Almost never
134
What is Truncus Arteriosus?
A single Artery Valve that forms, giving rise to both the Pulmonary Artery and the Aorta.
Usually the blood goes to the correct Artery though.
135
Typically Truncus is R->L or L->R lesion?
L->R
136
Is there much cyanosis with truncus?
Almost never/minimal--sats near normal (90's)
137
What is the major problem with Truncus?
Increased Pulmonary blood flow (both systole and diastole)
Decreased blood to coronary sinuses (easier for blood to go to pulm artery vs coronary arteries) ->MI, Ischemia & sudden death
138
When is repair of Truncus usually done?
Before Discharge
139
In repair of Truncus, the truncal valve stays connected to which ventricle?
LV (a conduit is connected RV to distal pulmonary artery)
140
W/single ventricle, if you have increased pulmonary blood flow w/o obstruction, you can have same physiology as what other lesion?
Large VSD/AVSD
141
What is the big problem w/single ventricle?
Excessive Pulmonary blood flow
142
What % of kids will have a mumur at some time?
80%
143
Murmurs are usually what?
May indicate what?
Benign
Structural Heart Dz
144
What grade murmur indicates an abnormaltiy of the heart?
3-6/6
145
What is the best part of your hand to feel a thrill?
The base of the fingers near the palms, feels like a cat purring.
146
"Innocent" murmurs are also called what?
| What kinds are there?
Functional or Normal
- Peripheral Pulmonic Stenosis Murmur (most common)
- Pulmonary flow murmur (esp anemia of prematurity)
- Transitional murmur
147
An innocent murmur is a systolic/diastolic murmur?
| Grade?
Systolic
Grade less than 4/6 (no thrill)
148
Where is a PPS murmur best heard?
What population has increased PPS murmurs?
Axillae (equally) & back (crescendo-decrescendo murmur)
Preemies--usually gone by 6 mos
149
What is a PPS murmur caused from?
Turbulence of flow at the Pulmonary Arteries
150
Where is a Pulmonary flow murmur heard?
Upper Left Sternal Border
151
What is a transitional murmur caused from? (2 types)
1. Closing PDA (can hear it into Diastole)
| 2. Transient Tricuspid Regurigation
152
Where would you hear a transitional murmur from PDA?
```
Upper Left Sternal Boarder
Systolic or continuous
Louder as PDA gets smaller
Occasionally Vibratory
Typically heard 12-48 hrs of age
```
153
Where would you hear a transitional murmur from Transient Tricuspid Regurgitation?
Lower Left Sternal Border
Regurgitant, systolic (blowing, holosystolic)
Heard in Asphyxiated or those w/PPHN
Resolves over several days
154
What murmurs need evaluation?
Loud
Diatolic
Don't fit into innocent murmur caetgory
Those w/other signs of CHD (Shock, CHF, Cyanosis)
155
What CHD presents as an Asymptomatic Murmur?
Septal Defects
Outflow Tract Obstruction
PDA
156
Where would you hear Aortic stenosis?
- Systolic, ejection
- Upper Right Sternal Border, Radiating to neck
- Systolic ejection click at apex (valvular sound)
- May have thrill in Suprasternal Notch
157
Babies w/anemia of prematurity often have what kind of murmur?
Pumonary flow murmurs
158
When babies are first born, RV and LV pressures are what?
Will you hear a VSD in the first day or so?
The same
No-it will increase as PVR falls. If it is large, may not have much turbulence->not much murmur heard
159
If a baby has a large VSD, they will have what signs?
Increased LA pressure
Increased pulmonary edema
Increased WOB
Poor growth
160
The murmur with an ASD is a/w pulmonary flow. Do you hear an Atrial murmur?
Is CHF seen with an ASD?
No, because the Atrial flow is low pressure.
No, not generally
161
Which Neonatal Arrhythmias are of concern?
1. Too fast
2. Too Slow
3. Too Irregular (could become too fast or too slow)
162
Name the 3 Tahcyarrhytmias
1. Sinus tachy
2. Supraventricular tachy
3. Ventricular tachy
163
What will you see with sinus tachy?
1. Narrow QRS
2. P waves visible
3. Rate <230
4. Gradual onset and termination
5. A/W underlying cause (fever, hypovolemia)
164
How do you tx sinus tachy?
Tx underlying cause (fever, fluids, etc)
165
What would you see w/SVT?
1. Narrow QRS
2. P waves burried in T wave
3. Rate >240, monotonous
4. Sudden onset and termination
5. Often result of re-entry
166
What is the most common form of SVT?
Wolff-Parkinson-White syndrome
-An accessory connection allowing conduction to go SA down the AV node or down the accessory conduction site-interfering w/normal rhythm causing pre-excitation
167
What do you do if a baby is in shock and has SVT?
Shock w/0.25-1 Joules/Kg
Synchronized DC cardioversion
Very unusual to need to do
168
If hemodynamically stable in SVT, what should you get before, during and after termination?
ECG
169
What are the usual tx's of acute SVT?
Valsalva (ice to face)
| Adenosine
170
Adenosine causes what?
Transient AV block
| Slows Sinus Node
171
Adenosine has an extremely short/long duration of action
Short
172
True/False: RBC's rapidly break down Adenosine.
True-so don't pull blood back into med syringe.
173
Does Adenosine work on Atrial Flutter?
| Accessory Connection-Mediated tachycardia?
No
| Yes
174
Ventricular tachy has what signs?
Wide QRS (maybe only slightly)
AV dissociation in VT
Underlying cause
175
If needing to synchronize DC cardiovert, what must be done after every shock?
Re-synchronize after every shock
176
In sinus bradycardia, what is slow?
Both atrial and ventricular rate
177
in AV block what is slow?
Ventricular rate is slower than Atrial
178
Sinus bradycardia is almost always what?
Vagally mediated
179
Besides vagal maneuvers, how can Sinus bradycardia be tx'd?
Atropine
Isoproterenol
Pacing
180
What is the Etiology of AV block?
```
Congenital
Surgical
Infectious
Vagal
Drugs
```
181
How do you tx Acute AV block?
Tx underlying cause
Drugs (Atropine, Isoproterenol)
Pacing
182
PAC's are very ________ & very ______
Normal & benign
normal QRS, P waves present (may be in T wave)
May be blocked or conducted aberrantly
183
Are PVC's common?
Are they normal?
What do they look like?
What are they from?
Yes
Yes
Wide QRS, no P-wave, may not be a pulse from PVC
Metabolic, Drugs, Mechanical stim (CVP cath inventricle), idopathic
