Cardiac Electrophysiology IV--evaluation and tx
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What is the first tool used in the evaluation of a patient with palpitations? | show 🗑
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What are the pros + limitations of using an ECG? | show 🗑
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show | Holter or Ambulatory monitoring; can provide beat by beat analysis of the rhythm; most helpful if symptoms occur at least once every 24 hours
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show | Useful if symptoms less frequent (once ever 2-6 weeks); patient wears recorder and activates it (must be conscious) when they get symptoms; information transmitted via telephone to central station
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What's an alternative to a loop recorder if the patient is frail or if the symptom includes frank syncope? | show 🗑
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When is signal averaged ecg useful? What types of ECG abnormalities affect the reliability of the measurement? | show 🗑
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What is heart rate variability (HRV) technique useful for? | show 🗑
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show | increased mortality; inspect using Heart rate variability (HRV)
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show | Looks at microvolt changes in T-wave amplitude; studies suggest that negative predictive power of test could be used to identify low risk population
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show | The electrophysiology study (EP); invasive
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What information does the EP study provide? | show 🗑
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Vaughn-Williams Class I drugs | show 🗑
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Vaughn-Williams Class II drugs | show 🗑
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Vaughn-Williams Class III | show 🗑
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Vaughn-Williams Class IV | show 🗑
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What 2 notable antiarrhythmics do not fit in the Vaughn-Williams classification? | show 🗑
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Vaughn-Williams Class IA drug actions | show 🗑
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Vaughn-Williams Class IB drug actions | show 🗑
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show | no change in ERP and A duration; decreased slope phase 0 & 4
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Vaughn-Williams Class II drug actions | show 🗑
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show | Increase AP duration and ERP; increased PR interval; increased QRS duration; increased QT duration
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show | Increased ERP of AV node, blocks slow Ca++ channel current
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show | GI distress, CNS symptoms, allergic reactions, lupus, thrombocytopenia, pro-arrhythmias, syncope
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Vaughn-Williams Class II side effects | show 🗑
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show | Amidarone: pulmonary toxicity, bradycardia, GI symptoms, thyroid and liver abnormalities. Sotalol: All class II side effects + proarrhythmia. Dofetilidie: torsade de Pointes
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show | Hypotension, bradycardia, worsening AV lock, Liver function abnormalities
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show | VW Class Ia, Ic, and III drugs; II and IV if AV ivolved; Ib do not appear useful
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show | Prevent embolic complications and treat abnormal rhythm
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show | RHEUMATIC VALVULAR DISEASE. CHF within last 3 months, history of hypertension or arterial thromboemboli, global LV dysfunction, LA size > 4.7 cm, left sided valvular abnormalities. No risk factors and < 60 yoa
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What two drugs have been shown to been effective in reducing the risk of stroke in patients with afib? | show 🗑
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CHADS2 risk factors | show 🗑
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How should you treat a patient with afib that is symptomatic and unstable? Minimally or asymptomatic? | show 🗑
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show | recurrent paroxysmal atrial fibrillation and recurrent persistent atrial fibrillation
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Antiarrhythmic drug therapy is needed for A.fib. patients if: | show 🗑
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show | Anticoagulation and rate control
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show | Advantages: inexpensive, widely available. Disadvantages: poorly controls rate during activity, digitalis toxicity serious problem
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What are some of the advantages + disadvantages of using beta and calcium channel blockers for rate control during a.fib.? | show 🗑
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What are some of the advantages + disadvantages of using amiodarone for rate control during a.fib.? | show 🗑
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What are some of the advantages + disadvantages of using AV node ablation for rate control during a.fib.? | show 🗑
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How do you treat atrial fibrillation in a patient with Wolff-Parkinson-White Syndrome? | show 🗑
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How do you treat VT in patients with CAD? | show 🗑
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How do you treat patients with AV node reentrant tachycardia and SVT associated with WPW? | show 🗑
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show | Supraventricular tachycardias and ventricular tachycardias
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show | Class I indications: symptomatic bradycardia; asystole > 3.0 seconds; symptomatic complete or high grade AV block; asymptomatic complete heart block with an escape rate <40 bpms
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show | Class I Indications: sudden cardiac death not due to transient or reversible cause; sustained, spontaenous VT; severe LV dysfunction that persists despite appropriate therapy
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show | Bi-ventricular pacing; up to 75% show improvement with reduction in LV size and increases in LV ejection fraction
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