Dysrhythmias

Question 1

What ECG abnormalities do you need to know about for the Step 3 exam? How are they treated?

Answer 1

Atrial fibrillation 
Atrial Flutter 
WPW with AVPR or AFib
Heart Block
1st degree
2nd degree
3rd degree
VT
VF 
PVCs
Sinus bradycardia 
Sinus Tachycardia

Question 2

What endocrine disease is suggested when a patient has sinus tachycardia or atrial fibrillation?

Answer 2

Hyperthyroidism. Check the level of thyroid-stimulating hormone (TSH) as a screening test.

Question 3

Which patients with atrial fibrillation should receive anticoagulation?

Answer 3

The CHADS2 score is used to estimate the risk of stroke in patients with nonrheumatic atrial fibrillation. The score is used to determine whether the patient should be treated with an anticoagulant (warfarin or dabigatran) or aspirin. The points in the following table are added to determine the CHADS2 score. A score of 0 indicates low risk of stroke, so aspirin can be used. A score of 1 indicates moderate risk, so aspirin or warfarin can be used. A score of 2 or greater indicates moderate or high risk, so warfarin should be used unless contraindicated (e.g., significant fall risk).

CONDITION POINTS
C Congestive heart failure 1
H Hypertension: blood pressure consistently >140/90 mm Hg (or taking antihypertension medication) 1
A Age >75 yr 1 D
Diabetes mellitus 1 S2 Prior stroke or transient ischemic attack 2

Question 4

What are the classic symptoms of Wolff-Parkinson-White syndrome?

Answer 4

A child becomes dizzy or dyspneic or passes out after playing and then recovers and has no other symptoms. The cause is a transient arrhythmia via the accessory pathway. ECG shows the infamous delta wave and shortened PR interval. The treatment of choice for such patients is radiofrequency catheter ablation of the pathway.