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30 Cards in this Set
- Front
- Back
causes of bradycardia
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dysfunction of sinus node, AV node, or His-Purkinje system; + reversible causes KIDLAT! (hyperK, drugs, Lyme, Thyroid disease)
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underlying cause of pathologic sinus bradycardia in most patients
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fibrotic replacement of the sinus node associated with aging (other causes - infarction, surgery damage, infiltrative processes, inc vagal tone, meds, genetic diseases)
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pathology in second degree AV blocks
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Mobitz type 1 is disease within AV node, type 2 more worrisome suggesting His Purkinje disease; HR of progressing to CHB
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two or more nonconducted P waves occur for each QRS complex
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Advanced second-degree heart block, or high-grade heart block
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pathology in CHB
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conduction block in His bundle or below
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treatment for symptomatic sinus bradycardia or heart block without reversible causes
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permanent pacemaker
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common causes of sinus tachycardia
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pain, fever, anxiety, anemia; in younger, SVTs, in older, AFib, aflutter, Vtach; any age - PACs and PVCs
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Class II and Class IV antiarrhythmics are contraindicated in
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decompensated systolic HF or WPW syndrome
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Class IC antiarrhythmics are contraindicated in
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after MI (increases risk of polymorphic VT)
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Class III agents (not amio)initiated, waht to watch out for?
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start in-patient over 3 days to monitor for torsades, if QTc >500 or increases by >15% or 60msec, decrease or discontinue dose
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S/E of amiodarone
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thyroid dysfunction, liver toxicity, pulmonary fibrosis, and skin hypersensitivity
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advantages of the newest antiarrhythmic agent dronedarone
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reduce hospitalization or death in Afib atrial or flutter, and less side effects cf amio
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S/E of dronedarone
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increased crea but does not change GFR; do not use in NYHA II or III with recent decompensation or Class IV; should not be used as rate control agent in those with permanent AFib
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MOA of adenosine
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blocks the A1 receptors in the AV node and can terminate reentrant SVTs
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what is paroxysmal, persistent and permanent Afib
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terminates on its own - paroxysmal; >7days - persistent; continuous and cardioversion has failed or no longer attempted - permanent
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atrial fibrillation occurs in the absence of structural heart disease in a patient younger than 60 years
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lone Afib
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Afib >48 hours, two strategies before cardioversion
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warfarin x 3 weeks then cardiovert or full anticoagulation then TEE, if NEG, then cardiovert
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post cardioversion of Afib, next step?
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4 weeks of warfarin with goal INR 2-3 because atrium is stunned
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when should cardioversion be done emergently in Afib?
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hypotension, angina or heart failure
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goal INR in patients with rheumatic mitral stenosis and atrial fibrillation
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2-3
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If a mechanical heart valve is present in a patient with atrial fibrillation, the level of anticoagulation is based on the type of valve, with a minimum INR of
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2.5
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Prasugrel in Afib?
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There is currently no role for prasugrel for stroke prophylaxis in atrial fibrillation
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RE-LY trial
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dabigatran was shown to be superior to warfarin in preventing ischemic and hemorrhagic stroke, with a reduced risk of life-threatening bleeding but a higher risk of gastrointestinal bleeding
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Rivaroxaban for Afib?
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approved for prevention of stroke and systemic embolism in atrial fibrillation. It is noninferior to warfarin for stroke prevention with no difference in major bleeding, but demonstrates a reduction in intracranial hemorrhage
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when should oral anticoagulation be interrupted in patients with Afib needing invasive procedures
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If the patient has a low short-term risk (CHADS2 score of 0-2) and the duration of interruption is less than 1 week, then bridging is not needed. If the patient has a higher short-term risk (CHADS2 score of 5-6, recent stroke, mechanical or rheumatic mitral valve) or if the interruption is more than 1 week, then use of a bridging agent should be considered more strongly
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resting heart rate goal for Afib
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<110 /min
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“pill-in-the-pocket” approach for patients with symptomatic paroxysmal Afib
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short-acting B-blocker or calcium blocker 30 minutes before flecainide or propafenone
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anticoagulation after afib ablation
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continue warfarin x 2-3 months, thereafter guided by CHADS2 score
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Nonpharmacologic strategies for Afib
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Afib ablation, AV node ablation, maze surgery
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involves several incisions or ablations in the right and left atria to interrupt potential reentrant pathways required for atrial fibrillation maintenance
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Maze surgery
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