Hosam Mohamed-
decrease slope of phase 4 depolarization, elevate threshold potential
What are the 2 mechanisms for decreasing automaticity?
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supraventricular tachycardia with uncoordinated atrial activation and poor atrial contraction
What is Atrial fibrillation?
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reduced CO, clots, stroke
What can Afib cause? (3)
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no p-wave
When looking at an ECG, how can we tell a patient is in Afib?
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hyperthyroid disorder, sleep apnea
What are two reversible causes of Afib?
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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
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palpitations, rapid heart beat, fatigue, SOB, worsening HF
Symptoms of AF? (5)
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A-flutter has consistent QRS intervals
What is the difference between A-Fib & A-Flutter on an ECG?
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control ventricular rate/hr, consider rhythm control, prevent stroke
What are the Goals of AF treatment? (3)
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rhythm control w direct current cardioversion (DCCV); electric shock
How do we treat patients who are hemodynamically unstable?
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class II-BB; Class IV- non-DHP
Which classes are our rate-control agents? (2)
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decreases risk of tachycardia-induced cardiomyopathy
Why do we use Rate control as first line instead of Rhythm control?
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<80 bpm
Goal HR for AF patients?
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c
Which agent do we use in AF + HF?
a) non-DHP CCBs
b) Beta-Blockers
c) Digoxin
d) amiodarone
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systolic HF, ischemic heart disease, AF triggered by sympathetic activity
BB's are preferred in patients with? (3)
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a
Which agent works by directly blocking the AV node?
a) non-DHP CCBs
b) Beta-Blockers
c) Digoxin
d) amiodarone
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a
Which agent do we AVOID in HF?
a) non-DHP CCBs
b) Beta-Blockers
c) Digoxin
d) amiodarone
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b
Which agent works by blocking sympathetic tone?
a) non-DHP CCBs
b) Beta-Blockers
c) Digoxin
d) amiodarone
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negative inotropic effects; constipation
Diltiazem is preferred over Verapamil because of less _______ & _______.
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HTN, pulmonary disease
When are non-DHP CCBs used in AF? (2)
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f; patients who are asymptomatic can remain in afib
We must always treat and cure a patient of AF. T/F?
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symptomatic despite rate control, unable to achieve rate control, 1st episode and likely to cardiovert, young age
When do we pursue Rhythm Control? (4)
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flecainide, propafenone, IV ibutilide, Dofetilide, amiodarone
What are our pharmacologic treatments for Rhythm control? (5)
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direct current cardioversion, ablation, MAZE procedure
What are our non-pharmacologic treatments for Rhythm control? (3)
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a
Which one shows you cells that have abnormal autorhythmiticity?
a) ablation
b) DCCV
c) MAZE
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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.
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no anticoag prior; CHADSVASc >=2 in men = 4 weeks; CHADSVASc >= 3= 3 weeks
Time in Afib= less than 48 hours
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3 weeks prior; 4 weeks after
Time in Afib= more than 48 hours or unknown
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perform TEE; if no clot seen then proceed with cardioversion
What if the patient can't wait 3 weeks? (2)
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class I or 3
No structural Heart disease =
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class III only
Structure Heart disease =
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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
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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
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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
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K >= 4.0, Mg >= 1.8, QTc <440 msec
Before a patient begins Dofetilide(Tikosyn) or Sotalol (Betapace) what parameters must they
reach? (3)
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HCTZ, verapamil, antihistamines
Which drugs interact with Dofetilide(Tikosyn) & Sotalol (Betapace) ? (3)
-
sotalol
Amiodarone is equal to ________ in cardioconversion.
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dofetilide
Amiodarone is equal to _________ in maintenance of Sinus Rhythm.
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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)
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moderate to severe mitral stenosis, mechanical heart valve
DOAC recommended over Warfarin UNLESS (2)
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>=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.
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whether or not we give a patient a DOAC
What are Based off CHA2DS2VASc scores used to determine?
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>= 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)
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removing cause, DCCV, IV magnesium
How do we treat Torsade De Pointes (TdP)? (3)
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hypokalemia/magnesemia, HF, MI, class Ia/ III AAD
Common causes of TdP? (4)
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acute MI, hx of CAD/LV dysfunction, H's & T's
Common causes of Vfib? (3)
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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
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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)
