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GEN MED II Final EXAM > Study for Gen Med II Final Part @ > Flashcards

Study for Gen Med II Final Part @ Flashcards

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1
Q

SVT

A

Impulses initiate from above the ventricles, anywhere really but we usually mean the SA node.

Over 160 bpm

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2
Q

SVT

A

Super Fast Impulses initiate from above the ventricles, anywhere really but we usually mean the SA node.

Over 160 bpm
Very Regular
Skinny QRS

If they come from anywhere other than the SA node, the p waves will have different shapes and we call that Multi Focal Tachycardia - it is an SVT but when we say SVT we mean either

ReEntry Tachycardia

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3
Q

SVT

A

Super Fast Impulses initiate from above the ventricles, anywhere really but we usually mean the SA node.

Over 160 bpm
Very Regular
Skinny QRS

If they come from anywhere other than the SA node, the p waves will have different shapes and we call that Multi Focal Tachycardia - it is an SVT but when we say SVT we mean either

ReEntry Tachycardia or AV Nodal ReEntry Tach
or

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4
Q

Most Common Cause of Palpitations in people with normal hearts

A

SVT: AV Nodal ReEntry Tachycardia

Fast/SLow Reentry

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5
Q

SVT

A

Super Fast Impulses initiate from above the ventricles, anywhere really but we usually mean the SA node.

Over 160 bpm
Very Regular
Skinny QRS

If they come from anywhere other than the SA node, the p waves will have different shapes and we call that Multi Focal Tachycardia - it is an SVT but when we say SVT we mean either

ReEntry Tachycardia or AV Nodal ReEntry Tach
Short PR with a delta wave slur as R rises from Q.

Wolf Parkinson White - Here SA impulses travel both through the AV Node but the Right Purkinje and also via the Bundle of Kent on the Right side of the heart.

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6
Q

SVT

A

Super Fast Impulses initiate from above the ventricles, anywhere really but we usually mean the SA node.

Over 160 bpm
Very Regular
Skinny QRS

If they come from anywhere other than the SA node, the p waves will have different shapes and we call that Multi Focal Tachycardia - it is an SVT but when we say SVT we mean either

ReEntry Tachycardia or AV Nodal ReEntry Tach
Short PR with a delta wave slur as R rises from Q.

Wolf Parkinson White - Here SA impulses travel both through the AV Node but the Right Purkinje fibers extend almost back to the Atrium and there is an open bundle of neuroconductive tissue there that conducts the impulse from the end of the Purkinjes BACK into the Atrium. These impulses go in through the AV and out through the Bundle of Kent and then BACK down the AV node, hopelessly circling.

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7
Q

Rate is 140 -250

Delta wave “slurs” beginning of QRS

A

Wolf Parkinson White

Cardiovert or

Use Adenosine or Verapamil IV (try Adenosine 1st

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8
Q

Rate is 140 -250

Delta wave “slurs” beginning of QRS

A

Wolf Parkinson White

Cardiovert or

Use Adenosine or Verapamil IV (try Adenosine 1st

Definitive Treatment is Ablation of the Bundle of Kent so it’s unavailable.

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9
Q

Metallic Taste & Feeling of “Impending Doom”

A

Adenosine Side Effects

Used for WPW SVT

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10
Q

SVT

A

Super Fast Impulses initiate from above the ventricles, anywhere really but we usually mean the SA node.

Over 160 bpm
Very Regular
Skinny QRS

If they come from anywhere other than the SA node, the p waves will have different shapes and we call that Multi Focal Tachycardia - it is an SVT but when we say SVT we mean either

ReEntry Tachycardia or AV Nodal ReEntry Tach
There are 2 paths through the AV Node: Fast & Slow. Fast goes direct to the ventricle and if Slow gets to the common ventricular path just after Fast goes through, it is shunted backwards up the fast path back into the atrium where it elicits another impulse.

Wolf Parkinson White - Here SA impulses travel both through the AV Node but the Right Purkinje fibers extend almost back to the Atrium and there is an open bundle of neuroconductive tissue there that conducts the impulse from the end of the Purkinjes BACK into the Atrium. These impulses go in through the AV and out through the Bundle of Kent and then BACK down the AV node, hopelessly circling.

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11
Q

Looks like super fast narrow QRSs separated by what look like notched T waves (but aren’t)

A

ReEntry SVT

Use Vagal Maneuvers/Unilateral Vagal Massage

Adenosine 6 mg IV Fast Push
If no Response in 1-2 min, double it
12 mg IV Fast Push
If no Response Cardiovert

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12
Q

Adenosine 6 mg IV Fast Push
If no Response in 1-2 min, double it
12 mg IV Fast Push
If no Response Cardiovert

A

Rx for SVT

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13
Q

DON’T USE DIGOXIN WITH

A

Wolf Parkinson White EVER

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14
Q

Looks like super fast narrow QRSs separated by what look like notched T waves (but aren’t)

Condition & Rx?

A

ReEntry & WPW SVT

Use Vagal Maneuvers/Unilateral Vagal Massage

Adenosine 6 mg IV Fast Push
If no Response in 1-2 min, double it
12 mg IV Fast Push
If no Response Cardiovert

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15
Q

Atrial Flutter Rx

A

Acute: Cardiovert. Anticoagulate w/Heparin if Flutter began more than 48 hours ago. No need if not 48 hrs into the rate.

To Manage: Amiodarone #1
or DoFetilide

Ablate if there is reentry to cure

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16
Q

AFIB Rx

A

If more than 48 hrs into the rhythm and you can do it, TEE to see if there are clots in the Rt Atrium.

If there are clots, anti coagulate for FOUR WEEKS, then cardiovert

If no clots cardiovert immediately

Either way, start Warfarin

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17
Q

AFIB Rx

A

If more than 48 hrs into the rhythm and you can do it, TEE to see if there are clots in the Rt Atrium.

If there are clots, anti coagulate for FOUR WEEKS, then cardiovert

If no clots cardiovert immediately

Either way, start Warfarin

For Rate Control, Use Amiodarone or DIG
Frankly, both are pretty dangerous but your Pt will need to come in for regular PT-INR checks on the warfarin so keep a good eye on your Dig levels - don’t know if one gets Amiodarone levels - watch for pulmonary fibrosis with Amiodarone.

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18
Q

40-60 bpm, regular but no p waves

A

Junctional

Junctional Tachycardia is over 100, regular and has no p-waves . Technically, its an SVT
It’s associated with DIG Toxicity and Heart Failure.

Accelerated Junctional Rhythm is 60-100, no p waves

J-Tach is different from ReEntry SVTs in that it’s totally flat between QRS complexes, no “notched T” look.

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19
Q

PR interval is constant but over 0.12 sec

A

1st Degree Heart Block

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20
Q

PR interval is Going Going and then a QRS is GONE

A

2nd Degree Winkibach/Movitz I

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21
Q

PR interval is Going Going and then a QRS is GONE, the p wave failed to get thru the AV node to the ventricles and we lost a QRS

Study These Flashcards
A

2nd Degree Winkibach/Movitz I

Due to Bradycardia. It Pt is on a beta blocker, reduce the dose.

If not caused by meds, consider pacemaker

22
Q

PR is constant and there’s just a missing QRS

Study These Flashcards
A

2nd Degree Heart Block, Movitz II

Frequently progresses to 3rd degree
Prepare for Pacemaker

23
Q

Ps march out completely unrelated to the QRSs

Study These Flashcards
A

3rd Degree Total Heart Block

24
Q

Ps march out completely unrelated to the QRSs

Study These Flashcards
A

3rd Degree Total Heart Block

Pacemaker Needed AV Node impassable

25
Sick Sinus Syndrome
SA node is wacky: Too Slow Too Fast Fast then Slow Then Fast Hard to catch on an EKG, Pt needs to wear a Holter Monitor around for days to see what's going on
26
Sick Sinus Syndrome
SA node is wacky: Too Slow Too Fast Fast then Slow Then Fast (Brady Tachy Synd) Hard to catch on an EKG, Pt needs to wear a Holter Monitor around for days to see what's going on
27
Sick Sinus Syndrome
SA node is wacky: Too Slow Too Fast Fast then Slow Then Fast (Brady Tachy Synd) Hard to catch on an EKG, Pt needs to wear a Holter Monitor around for days to see what's going on. This needs a pacemaker once you nail it.
28
Bundle Branch Block
There is a block in the bundle branch between HIS and the purkinkes. An alternate path forms in order to depolarize the ventricles. The alternate path takes longer so the unaffected ventricle contracts first then the affected ventricle goes. This results in a very wide QRS, likely with two R peaks (R & R-Prime) In Right BBB - the right ventricle depolarizes late and you see the Bunny ears in the right leads: V1 & V2 In Left BBB, the left one is late and you see bunny ears in I, aVL, V5 and/or V6. These might just be wide QRS (over .12) or there may be slurred Rs or actual bunny ears Left is suggestive of greater cardiac damage with a higher mortality rate Right is associated with Cor Pulmonale
29
Bundle Branch Block
There is a block in the bundle branch between HIS and the purkinkes. An alternate path forms in order to depolarize the ventricles. The alternate path takes longer so the unaffected ventricle contracts first then the affected ventricle goes. This results in a very wide QRS, likely with two R peaks (R & R-Prime) In Right BBB - the right ventricle depolarizes late and you see the Bunny ears in the right leads: V1 & V2 In Left BBB, the left one is late and you see bunny ears in I, aVL, V5 and/or V6. These might just be wide QRS (over .12) or there may be slurred Rs , notched Rs or actual bunny ears Left is suggestive of greater cardiac damage with a higher mortality rate Right is associated with Cor Pulmonale
30
VTACH is a ventricular driven Tachycardia with no SA node involvement
It is Lethal | It is a sinus-y wave on EKG and BIG
31
VTACH is a ventricular driven Tachycardia with no SA node involvement
It is Lethal | It usually starts as PVCs 3PVC=VTACH
32
VTACH is a ventricular driven Tachycardia with no SA node involvement
It is Lethal It usually starts as PVCs 3PVC=VTACH if a PVC lands on a T wave, VTACH may result. VTACH gets cardioverted
33
PVC
Premature Ventricular Tachycardia ectopic Ventricular pacemakers set off a contraction. PVCs from different ventricular pacemakers look different, you can count the ectopics involved this way 3 PVC = VTACH
34
VTACH is a ventricular driven Tachycardia with no SA node involvement Monomorphic - one shape to the huge QRSs. Monomorphics do look different in the different leads but within a lead, they'll look alike Polymorphic - more than one pacemaker tossing these contractions off, more than one QRS shape Torsades Des Points There can be polymorphous all from the same pacemaker, they don't look like Torsades but aren't monomorphic either
100-250 bpm Likely to proceed to VFib & quickly if it doesn't self resolve in 30 sec (non sustained VT) It usually starts as PVCs 3PVC=VTACH if a PVC lands on a T wave, VTACH may result. VTACH gets cardioverted
35
PVC
Premature Ventricular Tachycardia ectopic Ventricular pacemakers set off a contraction. PVCs from different ventricular pacemakers look different, you can count the ectopics involved this way 3 PVCs IN A ROW = VTACH Bigeminy = PVC every other normal QRS Trigem (every third QRS) & Quadrageminy too
36
VTACH is a ventricular driven Tachycardia with no SA node involvement Monomorphic - one shape to the huge QRSs. Monomorphics do look different in the different leads but within a lead, they'll look alike Polymorphic - more than one pacemaker tossing these contractions off, more than one QRS shape Torsades Des Points There can be polymorphous all from the same pacemaker, they don't look like Torsades but aren't monomorphic either Bidirectional VTach: Dig Toxicity QRSs go both up and down within the same lead.
100-250 bpm Likely to proceed to VFib & quickly if it doesn't self resolve in 30 sec (non sustained VT) It usually starts as PVCs 3PVC=VTACH if a PVC lands on a T wave, VTACH may result. VTACH gets cardioverted
37
Medication causes of Torsades
Drugs that lengthen QT interval: Procainamide/Quinidine Tricyclics (why we don't use them much now) Haloperidol ERYTHROMYCIN KETOCONIZOLE Compazine & Thorazine (antipsychotic) Phenergan (antiemetic- why we now use Zofran) AND HypOMagnesium - give MgSulfate to Torsades always. If K+ is low, give MgSO4 just in case as Mg & K run together.
38
VTACH Rx
If unstable (SOB or Hypoxic) Cardiovert ASAP 100-360 Joules If Pt is tolerating the rhythm w/o SOB/Hypoxia Give Lidocaine 1mg/Kg IV Bolus or Amiodarone 150mg SLOW bolus over 10 min then 1mg/minute over 6 hrs. This med will save the pt today but they'll likely die in 6 mo - its a trade off. Try Lidocaine and Cardioversion first.
39
VTACH Rx
If unstable (SOB or Hypoxic) Cardiovert ASAP 100-360 Joules If Pt is tolerating the rhythm w/o SOB/Hypoxia Give Lidocaine 1mg/Kg IV Bolus or Amiodarone 150mg SLOW bolus over 10 min then 1mg/minute over 6 hrs. This med will save the pt today but they'll likely die in 6 mo - its a trade off. Try Lidocaine and Cardioversion first. For maintenance: Amiodarone + BBlocker Implant a defibrillator
40
VTACH is a ventricular driven Tachycardia with no SA node involvement Monomorphic - one shape to the huge QRSs. Monomorphics do look different in the different leads but within a lead, they'll look alike Polymorphic - more than one pacemaker tossing these contractions off, more than one QRS shape Torsades Des Points There can be polymorphous all from the same pacemaker, they don't look like Torsades but aren't monomorphic either Bidirectional VTach: Dig Toxicity QRSs go both up and down within the same lead.
100-250 bpm but pretty REGULAR Likely to proceed to VFib (IRREGULAR) & quickly if it doesn't self resolve in 30 sec (non sustained VT) It usually starts as PVCs 3PVC=VTACH if a PVC lands on a T wave, VTACH may result. VTACH gets cardioverted
41
VFIB
IRREGULAR VENTRICULAR Tach 300-600bpm Multiple Foci w/Wandering Baseline No effective contraction so no blood is moving out of the heart - we have minutes only here!
42
The "H6T5" of VFib Causes:
``` Hypovolemia Hypoxia Hydrogen Ions (acidosis) Hyper K+ Hypo Glycemia Hypo Thermia ``` Toxin (dig? order drug levels) Tamponade (get ECHO) Tension Pneumothorax (Trachea midline? CXR) Thrombosis blocking Coronary Artery? (TPA) Trauma (back to hypovolemia & Tamponade)
43
VFIB Coarse VFiB is big Fine VFIB is small
IRREGULAR VENTRICULAR Tach 300-600bpm Multiple Foci w/Wandering Baseline No effective contraction so no blood is moving out of the heart - we have minutes only here! ``` DEFIBRILLATE ASAP!!! 200-300 JOULES DO IT 3X, ADDING JOULES EACH TIME THEN Add drugs: Lidocaine or Amiodarone Add: Epi for BP Add MgSO4 incase it's was a torsades vtach ``` If you save this guy, figure out what caused it MI? Drugs?
44
Most common cause of Cardiac Sudden Death in young Asian men under 30
Brugada Syndrome | RBBB
45
Right Ventricular Hypertrophy on EKG
R wave greater than S wave in V1
46
Right Ventricular Hypertrophy on EKG
R wave greater than S wave in V1 S wave greater than R wave in V6 recall left venter. hypertrophy is the R wave in V1 + Swave in V5 greater than 35
47
rate controller that can cause 1st degree block
BBlocker CCBlockers Dig
48
Prinzmetal's Angina is caused by vasospasm
Angina at rest in cycles Rx is Nifedipine
49
SVT medication
Adenosine 6mg Fast Push followed by Diltiazem if you break the rhythm
50
Don't Use Metropolol for
SVT

GEN MED II Final EXAM (2 decks)

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