decrease slope of phase 4 depolarization, elevate threshold potential
What are the 2 mechanisms for decreasing automaticity?
supraventricular tachycardia with uncoordinated atrial activation and poor atrial contraction
What is Atrial fibrillation?
reduced CO, clots, stroke
What can Afib cause? (3)
no p-wave
When looking at an ECG, how can we tell a patient is in Afib?
hyperthyroid disorder, sleep apnea
What are two reversible causes of Afib?
d
Onset within 48 hours.
a) recurrent AF
b) Permanent AF
c) Paroxysmal AF
d) Acute AF
e) Persistent AF
c
Terminates spontaneously in < 7 days.
a) recurrent AF
b) Permanent AF
c) Paroxysmal AF
d) Acute AF
e) Persistent AF
a
>= 2 episodes of AF.
a) recurrent AF
b) Permanent AF
c) Paroxysmal AF
d) Acute AF
e) Persistent AF
e
Duration > 7 days and doesn't terminate spontaneously.
a) recurrent AF
b) Permanent AF
c) Paroxysmal AF
d) Acute AF
e) Persistent AF
b
Does not terminate despite treatment.
a) recurrent AF
b) Permanent AF
c) Paroxysmal AF
d) Acute AF
e) Persistent AF
palpitations, rapid heart beat, fatigue, SOB, worsening HF
Symptoms of AF? (5)
A-flutter has consistent QRS intervals
What is the difference between A-Fib & A-Flutter on an ECG?
control ventricular rate/hr, consider rhythm control, prevent stroke
What are the Goals of AF treatment? (3)
rhythm control w direct current cardioversion (DCCV); electric shock
How do we treat patients who are hemodynamically unstable?
class II-BB; Class IV- non-DHP
Which classes are our rate-control agents? (2)
decreases risk of tachycardia-induced cardiomyopathy
Why do we use Rate control as first line instead of Rhythm control?
<80 bpm
Goal HR for AF patients?
c
Which agent do we use in AF + HF?
a) non-DHP CCBs
b) Beta-Blockers
c) Digoxin
d) amiodarone
systolic HF, ischemic heart disease, AF triggered by sympathetic activity
BB's are preferred in patients with? (3)
a
Which agent works by directly blocking the AV node?
a) non-DHP CCBs
b) Beta-Blockers
c) Digoxin
d) amiodarone
a
Which agent do we AVOID in HF?
a) non-DHP CCBs
b) Beta-Blockers
c) Digoxin
d) amiodarone
b
Which agent works by blocking sympathetic tone?
a) non-DHP CCBs
b) Beta-Blockers
c) Digoxin
d) amiodarone
negative inotropic effects; constipation
Diltiazem is preferred over Verapamil because of less _______ & _______.
HTN, pulmonary disease
When are non-DHP CCBs used in AF? (2)
f; patients who are asymptomatic can remain in afib
We must always treat and cure a patient of AF. T/F?
symptomatic despite rate control, unable to achieve rate control, 1st episode and likely to cardiovert, young age
When do we pursue Rhythm Control? (4)
flecainide, propafenone, IV ibutilide, Dofetilide, amiodarone
What are our pharmacologic treatments for Rhythm control? (5)
direct current cardioversion, ablation, MAZE procedure
What are our non-pharmacologic treatments for Rhythm control? (3)
a
Which one shows you cells that have abnormal autorhythmiticity?
a) ablation
b) DCCV
c) MAZE
a,c
Which is invasive?
a) ablation
b) DCCV
c) MAZE
c
Which is done when a patient has another open heart surgery?
a) ablation
b) DCCV
c) MAZE
ablation
-uses small burns or freezes to cause some scarring on the inside of the
heart to help break up the electrical signals that cause irregular
heartbeats.
no anticoag prior; CHADSVASc >=2 in men = 4 weeks; CHADSVASc >= 3= 3 weeks
Time in Afib= less than 48 hours
3 weeks prior; 4 weeks after
Time in Afib= more than 48 hours or unknown
perform TEE; if no clot seen then proceed with cardioversion
What if the patient can't wait 3 weeks? (2)
class I or 3
No structural Heart disease =
class III only
Structure Heart disease =
c
Which CANNOT be used in HF?
a) amiodarone
b) dofetilide
c) dronedarone
d) sotalol
e) propafenone
e
Which can be used as a "Pill-in-Pocket" option for infrequent Afib? (PRN)
a) amiodarone
b) dofetilide
c) dronedarone
d) sotalol
e) propafenone
f) flecainide
f
Which CANNOT be used in patients with structural heart disease?
a) amiodarone
b) dofetilide
c) dronedarone
d) sotalol
e) propafenone
f) flecainide
a
Which requires a loading dose then a maintenance dose?
a) amiodarone
b) dofetilide
c) dronedarone
d) sotalol
e) propafenone
f) flecainide
2nd/3rd degree AV block, hepatic disease, pulmonary disease, thyroid disorders, ocular disorders, electrolyte imbalance
Which conditions do we use Amiodarone with caution in? (6)
c
Which is contraindicated in permanent AFib?
a) amiodarone
b) dofetilide
c) dronedarone
d) sotalol
e) propafenone
f) flecainide
to prevent hospitalization related to AFib
Why is Dronedarone used?
b,d
Which has to be started in the hospital due to high chance of QTc
prolongation?
a) amiodarone
b) dofetilide
c) dronedarone
d) sotalol
e) propafenone
f) flecainide
K >= 4.0, Mg >= 1.8, QTc <440 msec
Before a patient begins Dofetilide(Tikosyn) or Sotalol (Betapace) what parameters must they
reach? (3)
HCTZ, verapamil, antihistamines
Which drugs interact with Dofetilide(Tikosyn) & Sotalol (Betapace) ? (3)
sotalol
Amiodarone is equal to ________ in cardioconversion.
dofetilide
Amiodarone is equal to _________ in maintenance of Sinus Rhythm.
once patient has failed at least 1 AAD
When is ablation recommended?
congestive HF, hypertension, age >= 75, diabetes, stroke/TIA, vascular disease, age>= 65, Sc= female
What does each letter stand for in CHA2DS2VASc ? (8)
moderate to severe mitral stenosis, mechanical heart valve
DOAC recommended over Warfarin UNLESS (2)
>=2 in men; >=3 in women
Based off CHA2DS2VASc scores, when do we recommend oral anticoagulation?
0 in men; 1 in women
Based off CHA2DS2VASc scores, when do we NOT recommend oral
anticoagulation?
1; 2
A score of ____ in men & _____ in women; it is up to the provider to decide
on oral anticoagulation.
whether or not we give a patient a DOAC
What are Based off CHA2DS2VASc scores used to determine?
>= 3 consecutive PVCs occurring at a rate of > 100 bpm
What is Ventricular Tachycardia? (Vtach)
implantable cardioverter-defibrillator (ICD)
-treatment option of choice for secondary prevention in patients at high risk
for recurrent, life-threatening ventricular arrhythmias.
c
How do we treat Vtach in an unstable patient?
a) beta blocker
b) ICD/Ablation
c) DCCV
d) amiodarone
a,d
How do we treat Vtach in a patient with mild symptoms?
a) beta blocker
b) ICD/Ablation
c) DCCV
d) amiodarone
b
How do we treat recurrent Vtach?
a) beta blocker
b) ICD/Ablation
c) DCCV
d) amiodarone
ischemia, metabolic imbalance, drug toxicity, hereditary
Common causes of Vtach? (4)
removing cause, DCCV, IV magnesium
How do we treat Torsade De Pointes (TdP)? (3)
hypokalemia/magnesemia, HF, MI, class Ia/ III AAD
Common causes of TdP? (4)
acute MI, hx of CAD/LV dysfunction, H's & T's
Common causes of Vfib? (3)
d
What is the best treatment for Vfib?
a) epinephrine
b) amiodarone
c) lidocaine
d) early cardioversion
a
Which can be used to improve perfusion in VFib?
a) epinephrine
b) amiodarone
c) lidocaine
d) early cardioversion
b,c
Which can improve long-term survival in VFib?
a) epinephrine
b) amiodarone
c) lidocaine
d) early cardioversion
remove causative agent, permanent pacemaker
How do we treat Bradyarrhythmias? (2)