Tisdale Flashcards
(110 cards)
1
Q
P-R interval represents
A
conduction time through AV node
2
Q
P wave represents
A
atrial depolarization
3
Q
QT interval represents
A
ventricular repolarization
4
Q
QRS represents
A
ventricular depolarization
5
Q
how to calculate HR from ecg
A
300/number large big squares in R-R interval
6
Q
big box is how long
A
0.2 sec
7
Q
little box is how long
A
0.04 seconds
8
Q
QTC interval higher in what gender
A
women
9
Q
if QTC higher than what, risk of Torsad
A
500 ms or 0.5 sec
10
Q
what is torsades de pointes
A
causes sudden cardiac death
ECG up and down like crazy
(twisting of the points)
11
Q
drug classes that may cause torsades
A
antiarryhtmic
anti microbials (macrolides and fluroquinolones, -cin)
antidepressants (citaloprams, pramines, lithium, mirtazapine, venlafaxine
antipsychotics (peridol, idone, azapine)
anticancer (nibs)
methadone
12
Q
types of supraventricular arrythmias
A
sinus bradycardia
sinus tachycardia
atrial fibrillation
AV block
supraventricular tachycardia
13
Q
types of ventricular arrythmias
A
ventricular fibrillation
ventricular tachycardia
prematrue ventricular complexes (PVCs)
14
Q
what is sinus bradycardia and where does it occur?
A
HR < 60 bpm, impulses from SA node
15
Q
sinus bradycardia MOA
A
decreased automaticity of SA node
16
Q
risk factors sinus bradycardia
A
prior MI/ischemia
abnormal sympathetic/parasympathetic tone
hyperkalemia or hypermagnesia
17
Q
drugs that could cause sinus bradycardia
A
beta blockers
verap and dilt
digoxin
amiodarone!!!
dronedarone
ivabradine
18
Q
symptoms of sinus bradycardia
A
hypotension
dizzy/faint
19
Q
treatment for sinus bradycardia
A
only if symptomatic
atropine 0.5-1 mg IV every 5 mins max: 3 mg
20
Q
second line sinus bradycardia
A
transcutaneous pacing
dopamine
epinephrine
isoproterenol
21
Q
adverse effects of atropine
A
tachycardia, urinary retention, blurred vision, dry mouth, mydriasis
22
Q
how to treat bradycardia following a heart transplant or spinal cord injury?
A
theophylline, aminophylline
23
Q
long term treatment sinus bradycardia
A
permanent pacemaker
theophylline
24
Q
afib atrial activity
A
chaotic and disorganized
25
ventricular rate afib
120-180 bpm
26
egc rhythm afib
irregularly irregular
no p waves
27
stage 1 afib
modifiable and non-modifyable risk factors
28
stage 2 afib
pre-afib
- atrial flutter
- atrial enlargement
- atrial premature beats
29
stage 3 afib
A: paroxysmal: lasts 7 or fewer days
B: persistent: lasts more than 7 days
C: long standing persistent: lasts more than 12 months
D: permanent: no further attempts at controlling
30
afib automaticity and mechanism
abnormal atrial and pulmonary vein automaticity
atrial re-entry
31
reversible afib etiologies
hyperthyroidism
sepsis
thoracic surgeries
32
increased morbidity and mortality conditions in pts with afib (4)
mortality
stroke / systemic embolism - huge risk
dementia
heart failure
33
afib treatment goals
prevent embolism
slow vent response ( ventricular rate control)
return to sinus rhythm
maintain sinus rhythm
34
CHADSVASC score
C - congestive HF
H - HTN
A - age 75+ (2)
D - diabetes
S - stroke/TIA (2)
V - vasc disease (PAD, MI hx, aortic plaque)
A - age 65-74
S - female
35
what CHADSVASC score should we give anticoags to for males and females?
1 in males
2 in females
36
when is warfarin preferred, and goal INRs
mechanical heart valve (2.5-3.5)
mitral valve stenosis (2-3)
37
warfarin or apixaban is preferred in who?
end stage CKD (CrCl < 15)
dialysis pts
38
which anticoag not reccomended for CrCl > 95
edoxaban
39
antidote for dabigatran
idaricizumab
40
antidote for apixaban, rivaroxaban, and edoxaban
andexanent alpha
41
apixaban special considerations
2.5 mg daily if:
SCr > 1.5
80+ years old
<60 kgs
42
apixaban and rivaroxaban are contraindicated with what drugs
strong CYPs: rifampin and phenytoin
43
drugs for ventricular rate control
verapamil
diltiazem
beta blockers: esmolol, propranolol, metoprolol
digoxin
amiodarone
44
amiodarone side effects
blue gray skin
photosensitivity
corneal microdeposits
pulmonary fibrosis
hepatotox
thyroid
hypotension
bradycardia
45
acute ventricular rate control afib treatment
if hemo unstable: DCC
if decomp HF: amiodarone
if stable and no decomp HF: beta, verap, dilt then dig then amio
46
hemodynamically unstable
SBP 90 or less
HR 150 or higher
lost conscious
ischemic chest pain
47
goal HR for pts after drug
<100-110 bpm and asymptomatic
48
patients with decompensated HF should not get
verapamil or diltiazem
49
long term ventricular rate control afib treatment
HFrEF (<=40%): beta blockers then dig
no HFrEF (>40%): verap, dilt, beta then dig
50
pts with HFrEF should not get
verapamil or diltiazem
51
when can we convert to sinus rhythm for afib?
if hemodynamically stable
- afib 48 hours or less
-afib greater than 48 hours need anticoag x 3 weeks or TEE to rule out a clot in atrium
52
drugs for conversion to sinus rhythm afib
DCC
amiodarone
ibutilide
procainamide
flecainide
propafenone
53
conversion to sinus rhythm afib drugs with risk of torsades de pointes
amiodarone (QT)
ibutilide
procainamide (QT)
54
which drugs to not use together, conversion to sinus rhythm afib
amiodarone and ibutilitde should not be used with procainamide
55
conversion to sinus rhythm afib treatment
must be hemodynamically stable
normal LV function: IV amio or ibutilide, or procainamide
HFrEF: IV amiodarone
not in hospital: flecainide or propafenone
56
drugs for maintenance of sinus rhythm afrib
amiodarone
dofetilide
dronedarone
flecainide
propafenone
57
what drugs is dofetilide contraindicated with?
verapamil, cimetidine, thiazide diuretics, ketoconazole, trimethoprim
58
dronedarone side effects
diarrhea
nausea
rash
NO THYROID/PULM FIBROSIS
59
dofetilide renal dosing
CrCl > 60: 500 mcg BID
CrCl 40-60: 250 mcg BID
CrCl 20-39: 125 mcg BID
CrCl < 20: contraindicated
60
amiodarone monitoring
thyroid tests every 6 months
LFTs every 6 months
ECG annually
chest x ray for pulm fibrosis
derm
eye doc
61
continuation of sinus rhythm afib treatments
normal LV function: dofetilide, dronedarone, flecainide, propafenone THEN amiodarone THEN sotalol
prior MI, HFrEF, struct disease: dofetilide, dronedarone, amiodarone THEN sotalol
- if decomp HF recently or NY III: no dronedarone
62
patients with history MI, structural heart disease, or HFrEF should not get what drug for afib maintain sinus rhythm
flecainide or propofenone
63
patients with NYHA III or decomp HF recently should not get what drug in afib
dronedarone
64
patients starting dofetilide or sotalol must do what
be in hospital for 3 days during initiation for continuous ECG monitoring
65
what to do after dofetilide first dose
after 2-3 hours post dose, check QTC interval
- if 15% increase or less keep dose
- if > 15% increase or 500 ms half dose
66
what to do dofetilide second dose
check qtc and if over 500 we stop
67
what qtc interval must patient have to start dofetilide
440 ms or less
68
what qtc interval must patient have to start sotalol
450 ms or less
69
sotalol dosing renal
CrCl > 60 : 80 mg BID
CrCl 40-60: 80 mg daily
CrCl < 40: CI
70
supraventricular tachycardia rhythm and HR
regular rhythm
110-250 bpm
71
paroxysmal SVT
intermittent episodes, lasts minutes to hours
72
supraventricular tachycardia mechanism
re-entry through AV node
73
risk factors supraventricular tachycardia
women
older
no history cardiovascular cond
74
key symptom supraventricular tachycardia
neck pounding
75
drugs for supraventricular tachycardia
adenosine
beta blockers: esmolol, propranolol, metoprolol
verapamil
diltiazem
76
adenosine dosing
6 mg IV, 1-2 mins later 12 mg, then 12 mg
77
which drugs for supraventricular tachycardia should not be used for pts with heart failure
verapamil or diltiazem
78
supraventricular tachycardia termination of SVT treatment
IV adenosine
then beta block, verap, or dilt
then DCC
79
SVT treatment for prevention
only if symptomatic
1st - catheter ablation
no HFrEF: beta block, verap, dilt THEN flecainide or propafenone
HFrEF: amiodarone, dofetilide, digoxin, sotalol
(no flec or prop with CAD)
80
which drugs for SVT are contraindicated in CAD
flecainide and propafenone
81
PVC on ECG characteristic
wide QRS, upside down
normal sinus rhythm
82
bigeminy
trigeminy
every 2nd or 3rd beat is a PVC
83
frequent PVCs defined as
>30 per hour
one on a 12 lead ECG
84
mechanism of PVCs
increased automaticity of ventricular muscle cells/Purkinje fibers
85
is there re-entry in PVCs
no
86
symptoms of PVCs
usually asymptomatic
-palpatations
-dizziness
-light headedness
87
very frequent PVC definition and risk
>10,000 per day
risk cardiomyopathy
88
PVCs associated with increased mortality in what disease group
CAD
89
PVCs associated with sudden cardiac death risk for who
MI hx, frequent PVCs
90
treatment of PVCs
asymptomatic = none
no HF = beta block, dilt, verap
HF = beta block
unresponsive = antiarrhythmic or catheter ablation
91
ventricular tachycardia rhythm
regular (100-250 bpm)
92
ventricular tachycardia ECG pattern
wide QRS, >3 consecutive PVCs at rate of >100 bpm
93
nonsustained vent tachycardia def
three or more consecutive PVCs that terminate spontaneously
94
sustained VT definition
VT lasting greater than 30 seconds or requiring termination because of hemodynamic stability < 30 seconds
95
sustained monomorphic VT
idiopathic ventricular tachycardia, verapamily sensistive, pts with no structural heart disease
96
mechanism of ventricular tachycardia
increased automaticity in ventricular tissue
97
is there re-entry in ventricular tachycardia
yes, in ventricles
98
drugs that could cause v tach
digoxin
flecainide
propofenone
99
which two antiarrythmics should not be given to pts with CAD history
flecainide and propofenone
100
electrolyte risk factors for getting v tach
hypokalemia and hypomagnesia
101
what is outflow track VT
VT occurring in the right or left ventricle outflow tract
102
ventricular tachycardia drugs for termination of VT
procainamide
amiodarone
sotalol
verapamil
beta blockers
103
treatment for termination of hemodynamically stable VT
structural heart disease: DCC, IV procainamide, IV amiodarone or sotalol
no structual heart disease: verapamil or beta blocker (outflow = beta)
104
if med given for VT and didn't work what should we do
DCC
105
what is an ICD
implantable cardioverter defibrillator
106
drugs / prevention of recurring VT or sudden cardiac death
ICD
amiodarone
sotalol
catheter ablation
107
what does ventricular fibrillation look like
irregular disorganized chaotic electrical activity
no QRS complexes
108
ventricullar fibrillation treatment
CPR
defib shock
epinephrine 1 mg
defib shock
amiodarone 300 mg / lidocaine 1-1.5 mg/kg
defib shock
epi
defib shock
109
epinephrine given every ____ in v fib
3-5 mins
110
