Unit 3: 5 Antiarrhythmic Medications Overview

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Questions and Answers

Which of the following is NOT an indication for immediate referral to cardiology in patients with cardiac arrhythmias?

Well-controlled symptoms of the arrhythmia (correct)

Suspected cardiac structure involvement

Signs of acute myocardial infarction

Hemodynamic instability

What is the classification based on heart rate for bradyarrhythmias?

Greater than 100 beats/min

Less than 30 seconds

Greater than 100 beats/min

Less than 60 beats/min (correct)

In terms of origin, what distinguishes a multifocal arrhythmia from a unifocal arrhythmia?

The number of QRS complexes

The presence of P waves

The speed of the heart rate

The points of origin (focus) (correct)

What characteristic typically follows a premature ventricular contraction (PVC) in the cardiac rhythm?

A compensatory pause Signup and view all the answers

What is the main therapeutic goal in the long-term treatment of atrial fibrillation?

Preventing thromboembolism Signup and view all the answers

Which agents are preferred in the management of wide-complex PSVT due to their effect on increasing the refractoriness of the bypass tract?

Class IA, IC, III antiarrhythmic agents Signup and view all the answers

What is the INR range that warfarin dose should be titrated to maintain in patients with atrial fibrillation?

2 - 3 Signup and view all the answers

What is one drawback of using warfarin as an oral anticoagulant in patients with atrial fibrillation?

Constant monitoring required Signup and view all the answers

Which component is NOT traditionally included in the treatment of patients with atrial fibrillation?

Ventricular tachycardia management Signup and view all the answers

Which therapy may be added if a patient with atrial fibrillation has symptoms beyond anticoagulation and rate control interventions?

Rhythm control therapy Signup and view all the answers

Why is catheter ablation preferred over antiarrhythmic agents in the management of atrial fibrillation?

Safety and tolerability concerns Signup and view all the answers

Which pharmacological agents have the potential to cause a faster ventricular rate when used alone in wide-complex PSVT?

[Digoxin, CCB, beta blockers] Signup and view all the answers

"An early referral to cardiology and an electrophysiologist may be considered part of the initial management of the AF patient". What aspect of patient care does this statement emphasize?

[Patient preference] Signup and view all the answers

"Recent studies have called attention to include risk factor modification as the fourth aspect of management". What are examples of risk factors mentioned in the text?

[Obesity, sleep apnea] Signup and view all the answers

In second-degree AV block Mobitz type I, what happens to the PR interval as the rhythm progresses?

It progressively prolongs Signup and view all the answers

Which type of second-degree AV block has a higher propensity to progress to complete heart block?

Type II Signup and view all the answers

What characterizes a second-degree AV block Mobitz type II?

Constant PR interval Signup and view all the answers

What is another term for third-degree AV block?

Complete Heart Block Signup and view all the answers

In a first-degree AV block, what happens to the PR intervals compared to normal values?

Longer than normal Signup and view all the answers

What differentiates second-degree AV blocks from other blocks?

'Skipped' QRS complexes in a timed fashion Signup and view all the answers

Which part of the heart's electrical journey results in an intraventricular block?

'Bundle branches' Signup and view all the answers

'SA exit block' is characterized by:

'Long pauses' in sinus rhythm caused by sudden cessation Signup and view all the answers

'Atrioventricular nodal blocks' are characterized by:

'Delayed conduction' through the AV node Signup and view all the answers

'Sinus Bradycardia' is identified by which heart rate characteristic?

< 60 beats/min Signup and view all the answers

'Premature ventricular contraction' (PVC) are associated with:

'Ventricular Tachyarrhythmias' Signup and view all the answers

In first-degree AV block, what happens to every P wave?

Is conducted to the ventricle with a related QRS complex. Signup and view all the answers

What is the main difference between junctional escape rhythm and ventricular escape rhythm?

The rate of junctional escape rhythm is slower than that of ventricular escape rhythm. Signup and view all the answers

What is the hallmark characteristic that distinguishes a left bundle branch block (LBBB) on an ECG?

Broad, slurred S wave in lead V1 Signup and view all the answers

In complete right bundle branch block, what is the typical duration of the QRS complexes?

0.12 second or longer Signup and view all the answers

What ECG finding is associated with left posterior hemiblock?

Right-axis deviation Signup and view all the answers

Which factor plays a major role in determining the effect of an arrhythmia on hemodynamics?

The severity of underlying heart disease Signup and view all the answers

What is the first priority when managing cardiac arrhythmias?

Establish the presence of a pulse Signup and view all the answers

What is the primary goal when evaluating a bundle branch block using a 12-lead ECG?

Differentiate between complete and incomplete bundle branch block Signup and view all the answers

'Hemiblock' occurs when conduction is impaired in which part of the left bundle branch?

Left anterior fascicle Signup and view all the answers

'Proarrhythmia' refers to what potential effect of antiarrhythmic medications?

'Proarrhythmia' is a side effect leading to worsening of arrhythmias. Signup and view all the answers

What is the primary reason for individualizing long-term antiarrhythmic therapy?

To avoid drug-induced proarrhythmia Signup and view all the answers

Which of the following is NOT a general condition for appropriate antiarrhythmic therapy?

Presence of systemic infection Signup and view all the answers

'Nonpharmacological Management' for arrhythmias includes which strategy?

'Nonpharmacological Management' starts with eliminating stimulants that could provoke the arrhythmia. Signup and view all the answers

'Interprofessional Collaborative Management' emphasizes establishing the presence of:

'Interprofessional Collaborative Management' emphasizes establishing hemodynamic stability. Signup and view all the answers

Which class of antiarrhythmic drugs does amiodarone belong to?

Class III Signup and view all the answers

What is the primary approach to managing sinus tachycardia?

Treatment or elimination of the underlying cause Signup and view all the answers

What heart rate range defines the syndrome of inappropriate sinus tachycardia (IST)?

>90 beats/min at rest for longer than 24 hours Signup and view all the answers

Which medication holds considerable promise for treating the syndrome of inappropriate sinus tachycardia (IST)?

Ivabradine (Corlanor) Signup and view all the answers

What percentage of patients with multifocal atrial tachycardia have significant pulmonary disease?

60% Signup and view all the answers

'Paroxysmal Supraventricular Tachycardia' mainly occurs in which age group?

Elderly patients with comorbid disease Signup and view all the answers

'Paroxysmal Supraventricular Tachycardia' usually occurs in the setting of which condition?

'Congestive HF' Signup and view all the answers

'Adenosine' is contraindicated in patients with which condition?

'Asthma' Signup and view all the answers

What is the appropriate next step if vagal maneuvers do not slow the ventricular rate in 'Paroxysmal Supraventricular Tachycardia'?

Administer verapamil or diltiazem after adenosine fails Signup and view all the answers

What additional precaution is recommended when using intravenous verapamil or diltiazem in 'Paroxysmal Supraventricular Tachycardia'?

Ensure availability of an external cardioverter-defibrillator as atrial fibrillation may occur after use of these medications. Signup and view all the answers

What is the recommended approach for managing sustained ventricular tachycardia (VT) with a pulse?

Treatment at an acute care facility Signup and view all the answers

Which therapy is not mentioned as a possible option for preventing recurrent sustained VT?

Antibiotic therapy Signup and view all the answers

Why is sotalol initiated in an inpatient setting with continuous ECG monitoring?

To minimize the risk of torsades de pointes Signup and view all the answers

What remains the first-line therapy for patients with systolic heart failure (HF) and after acute myocardial infarction (MI)?

Beta blockers Signup and view all the answers

Which factor Xa inhibitor is contraindicated for patients with nonvalvular AF if their creatinine clearance is greater than 95 mL/min?

Edoxaban Signup and view all the answers

What is the approved antidote for patients with AF who develop uncontrollable bleeding while taking dabigatran?

Idarucizumab Signup and view all the answers

Which medication was identified as the safest DOAC for stroke prevention in Afib in a 2018 review of 320 articles?

Apixaban Signup and view all the answers

Which type of medication is dabigatran?

Prodrug Signup and view all the answers

Which enzyme metabolizes dabigatran?

Cytochrome P-450 system Signup and view all the answers

Which group of medications are substrates for the efflux transporter P-glycoprotein?

Factor Xa inhibitors Signup and view all the answers

Antiplatelet monotherapy is not recommended for stroke prevention in AF patients due to:

Potential for increased bleeding risk Signup and view all the answers

Combinations of oral anticoagulants and platelet inhibitors increase:

Bleeding risk Signup and view all the answers

P-glycoprotein inducers can decrease plasma concentrations of which group of medications?

Factor Xa inhibitors Signup and view all the answers

Renal status should be established with serum creatinine before initiation of therapy with these medications, and then periodically during use of the medication. This statement primarily aims to monitor for:

Renal function changes Signup and view all the answers

Why are these medications not recommended in patients with AF and mechanical heart valves?

Lack of safety and efficacy studies in this population Signup and view all the answers

Which antiarrhythmic drug should be avoided with dronedarone due to potential interactions?

Sotalol Signup and view all the answers

What is the most effective antiarrhythmic drug for maintaining sinus rhythm in patients with paroxysmal or persistent atrial fibrillation?

Amiodarone Signup and view all the answers

What is a serious side effect associated with the administration of amiodarone, whether intravenous or oral?

Proarrhythmias Signup and view all the answers

Which organ does amiodarone accumulate in due to its long half-life?

Skin Signup and view all the answers

Prior to initiation of amiodarone, what baseline tests should be performed?

Thyroid function tests Signup and view all the answers

Which procedure may be considered for controlling tachyarrhythmia in atrial fibrillation?

Maze procedure Signup and view all the answers

What risk is associated with electrical and pharmacologic cardioversion in patients with atrial fibrillation?

Thromboembolism Signup and view all the answers

How long should anticoagulation therapy be uninterrupted before elective cardioversion if the rhythm has been sustained for longer than 48 hours?

4 weeks Signup and view all the answers

What is the preferred drug choice for managing premature ventricular contractions in patients with a structurally normal heart in a primary care setting?

Beta blockers Signup and view all the answers

What should management of non-sustained ventricular tachycardia include as a first step?

Identification and management of any underlying cause Signup and view all the answers

What is the next step if complex ventricular ectopy is identified in a patient with a structurally normal heart?

Evaluation for underlying cardiac disease Signup and view all the answers

Which medication can be added to assist in rate control, particularly when EF is < 30%?

Digoxin Signup and view all the answers

What is considered the ideal resting heart rate according to historical views?

60 to 75 beats/min Signup and view all the answers

Which drug therapy combination is particularly useful for controlling heart rate in patients with low ejection fraction?

Beta blockers and Digoxin Signup and view all the answers

What is the primary reason for choosing restoration of sinus rhythm in atrial fibrillation patients?

To relieve symptoms, prevent embolism, and reduce risk of HF Signup and view all the answers

Which antiarrhythmic drug is typically used for long-term symptom control but carries a risk of proarrhythmia?

Flecainide Signup and view all the answers

What is a common side effect associated with the use of sotalol for rate control in arrhythmias?

Torsades de pointes Signup and view all the answers

In addition to being antiarrhythmic, which class of drugs also have rate-limiting properties?

Amiodarone Signup and view all the answers

'The 2010 Rate Control Efficacy in Permanent Atrial Fibrillation: a Comparison between Lenient versus Strict Rate Control II (RACE II)' study revealed that lenient heart rate control was noninferior to strict rate control without causing what adverse outcomes?

Increased heart failure or deaths Signup and view all the answers

'Ablation of the atrioventricular node/His bundle and implantation of a permanent ventricular pacemaker' is a procedure used to control ventricular rate when medications fail. What risk is associated with this procedure?

High short-term mortality risk Signup and view all the answers

'Rhythm Control in Atrial Fibrillation' considers which patient factor as a major consideration in determining treatment?

'Tolerance of lost atrial contraction' Signup and view all the answers

Which factor plays a major role in determining the effect of an arrhythmia on hemodynamics?

Rate of the arrhythmia Signup and view all the answers

What is the first priority when managing cardiac arrhythmias?

Establishing the presence of a pulse Signup and view all the answers

What additional precaution is recommended when using intravenous verapamil or diltiazem in 'Paroxysmal Supraventricular Tachycardia'?

Having calcium chloride available Signup and view all the answers

'SA exit block' is characterized by:

Progressive prolongation of the P-P interval until a sinus pause occurs Signup and view all the answers

Which classification system is mentioned as the most commonly used for antiarrhythmic medications?

Vaughn-Williams Signup and view all the answers

What is the definition of inappropriate sinus tachycardia (IST) in terms of heart rate at rest?

Heart rate >90 beats/min Signup and view all the answers

Which medication holds considerable promise for treating IST and has shown symptom reduction in 70% of patients?

Ivabradine Signup and view all the answers

Which class of antiarrhythmic medications includes drugs like sotalol, dofetilide, and amiodarone?

Class III - potassium channel blockers Signup and view all the answers

What is the primary approach to addressing sinus tachycardia when the underlying cause is removed but tachycardia persists?

Considering syndrome of inappropriate sinus tachycardia (IST) Signup and view all the answers

In the context of antiarrhythmic medications, what does proarrhythmia refer to?

Worsening of the arrhythmia Signup and view all the answers

What condition is multifocal atrial tachycardia primarily associated with?

Pulmonary disease Signup and view all the answers

'Syndrome of Inappropriate Sinus Tachycardia' is defined as a sinus-initiated heart rate higher than __ beats/min at rest for longer than 24 hours.

>90 beats/min Signup and view all the answers

Which antiarrhythmic medication should be avoided in patients with permanent AF, HF, or left ventricular systolic dysfunction due to increased risk of stroke, MI, systemic embolism, and cardiovascular death?

Dronedarone Signup and view all the answers

Which medication is considered the most effective for maintaining sinus rhythm in patients with paroxysmal or persistent AF, outperforming sotalol, propafenone, and dronedarone?

Amiodarone Signup and view all the answers

Which antiarrhythmic drug has a very long half-life of 40 to 50 days and can accumulate in the skin, liver, and cornea?

Amiodarone Signup and view all the answers

Before initiating amiodarone, what baseline monitoring parameters are imperative to attain?

Liver and thyroid function tests Signup and view all the answers

Which category of medications should be avoided when administering dronedarone due to potential interactions with CCBs, antiseizure medications, and others metabolized by the CYP3A or CYP2D6 hepatic pathways?

Other antiarrhythmics Signup and view all the answers

Which antiarrhythmic drug should be initiated by a physician in the hospital with a loading dose followed by maintenance therapy due to its risk of proarrhythmias and lethal arrhythmias?

Amiodarone Signup and view all the answers

What is the recommended initial treatment for Paroxysmal Supraventricular Tachycardia (PSVT) after vagal maneuvers?

Adenosine Signup and view all the answers

Why is adenosine contraindicated in patients with asthma?

It may cause worsening of bronchospasm Signup and view all the answers

What is the preferred pharmacological treatment for narrow-complex PSVT?

Calcium channel blockers (CCB) Signup and view all the answers

Why is caution necessary when managing wide-complex PSVT with pharmacologic agents?

To avoid ventricular rate speeding up Signup and view all the answers

Why is radiofrequency ablation preferred over antiarrhythmic agents in most cases of PSVT?

Because of safety and tolerability concerns Signup and view all the answers

What is a key factor to consider when managing patients with Atrial Fibrillation (AF) or atrial flutter?

Risk factor modification, symptoms, and underlying conditions Signup and view all the answers

'Stroke risk in patients with non-valvular AF can be assessed using which scoring system?

CHA2DS2-VASc score Signup and view all the answers

'Risk factor modification' as part of AF management includes all of the following EXCEPT:

$\text{Use of Class IA antiarrhythmic agents}$ Signup and view all the answers

'Rate control' therapy for AF aims to maintain heart rate between:

$90$ and $110$ bpm Signup and view all the answers

'Rhythm control' therapy in AF should be considered when:

$\text{The patient remains symptomatic beyond initial interventions}$ Signup and view all the answers

Prevention of Thromboembolism in AF primarily aims to reduce the risk of:

<pre><code>ext{Stroke and embolism} </code></pre> Signup and view all the answers

What is the primary reason for the continuous monitoring required for patients taking warfarin?

To monitor INR levels Signup and view all the answers

Which enzyme metabolizes dabigatran?

Cytochrome P-450 system Signup and view all the answers

Why are factor Xa inhibitors contraindicated with strong CYP3A4 inducers?

They are metabolized by this enzyme Signup and view all the answers

What action is necessary before initiating one of the direct thrombin or factor Xa inhibitors medications?

Check for creatinine clearance Signup and view all the answers

Which medication is identified as the safest DOAC for stroke prevention in Afib according to a 2018 review?

Apixaban Signup and view all the answers

What is the antidote approved by the FDA for patients experiencing uncontrollable bleeding while on rivaroxaban or apixaban?

ANDEXXA Signup and view all the answers

Which group of medications are substrates for P-glycoprotein?

Factor Xa inhibitors Signup and view all the answers

'Nonvalvular AF' refers to atrial fibrillation in patients who do not have what condition?

Congenital heart defects Signup and view all the answers

What is contraindicated for patients with nonvalvular AF if their creatinine clearance is greater than 95 mL/min?

Edoxaban Signup and view all the answers

What is a major consideration before initiating therapy with direct thrombin or factor Xa inhibitors?

Renal function assessment Signup and view all the answers

Why should patients with AF and end-stage chronic kidney disease (or dialysis) not use direct thrombin or factor Xa inhibitors?

Lack of clinical trial evidence Signup and view all the answers

Which age group is identified as having a minor risk factor for stroke in the CHA2DS2-VASc scoring system?

65-74 years Signup and view all the answers

What is considered the ideal resting heart rate for patients with atrial fibrillation?

60-75 beats/min Signup and view all the answers

Which study revealed that lenient heart rate control in atrial fibrillation was noninferior to strict rate control?

RACE II Signup and view all the answers

What is a primary consideration when evaluating treatment options for atrial fibrillation regarding the patient's tolerance of lost atrial contraction?

Risk of cardiomyopathy Signup and view all the answers

Which drug can be added to assist in rate control in atrial fibrillation if necessary due to its inotropic properties?

Digoxin Signup and view all the answers

What is the potential consequence of AV nodal ablation in symptomatic patients with atrial fibrillation?

Dependence on a pacemaker Signup and view all the answers

Rate control is an acceptable goal in hemodynamically stable patients with atrial fibrillation. Which of the following medications is NOT commonly used for rate control?

Amiodarone Signup and view all the answers

Rhythm control aims to restore normal sinus rhythm in patients with atrial fibrillation. What specific parameter should be evaluated before attempting restoration of sinus rhythm?

Thromboembolism risk Signup and view all the answers

Combination therapy involving beta blockers and digoxin is useful for rate control in patients with atrial fibrillation. What characteristic of the patient influences the choice between these medications?

<code>Renal function</code> Signup and view all the answers

Which class of medications should be used sparingly and only in patients needing rhythm control therapy due to their significant side effects?

Antiarrhythmic drugs Signup and view all the answers

What initial management is recommended for an unstable patient with a bradyarrhythmia?

Evaluation and possible implantation of a pacemaker Signup and view all the answers

Which drug class should be reviewed for potential bradyarrhythmia side effects in patients with a bradyarrhythmia?

Opioids Signup and view all the answers

What is a potential reversible cause of bradyarrhythmia mentioned in the text?

Lyme disease Signup and view all the answers

When should a referral to a cardiologist be considered for a patient with bradyarrhythmia?

When a reversible cause cannot be identified or corrected Signup and view all the answers

What is the initial emergency medication used for bradyarrhythmia?

Atropine Signup and view all the answers

In which type of bradyarrhythmia might atropine not effectively restore atrial rate?

Heart blocks Signup and view all the answers

Which medication must be used with caution in patients with coronary risk factors due to its potential to worsen ischemia and cause MI?

Atropine Signup and view all the answers

When is pacing discouraged in asymptomatic patients with suspected sinus node dysfunction?

When resting heart rates are lower than 40 beats/min Signup and view all the answers

What is the initial priority for managing any type of new heart block?

Identifying underlying causes Signup and view all the answers

What may be responsible for causing heart blocks when the heart is structurally normal?

Digitalis Signup and view all the answers

Which medication reverses cholinergic-mediated reductions in AV nodal conduction and may be useful in treating first-degree AV block?

Atropine Signup and view all the answers

What should be performed for any type of new heart block?

Correction of underlying causes Signup and view all the answers

What is a potential cause of heart blocks in structurally normal hearts?

Digitalis Signup and view all the answers

Which of the following conditions may cause sinus tachycardia in adults?

Fear Signup and view all the answers

Which of the following is a potential risk factor for atrial fibrillation?

Holiday heart syndrome Signup and view all the answers

What is the primary treatment goal in atrial fibrillation with a rapid rate?

Control symptoms Signup and view all the answers

When should any new onset of atrial fibrillation be referred to a cardiologist?

Urgently for evaluation Signup and view all the answers

What is the primary factor used to determine when to start anticoagulation therapy in patients with atrial fibrillation?

CHA2DS2-VASc score Signup and view all the answers

Which condition can be considered for anticoagulation therapy even with a CHA2DS2-VASc score of 1?

Female sex Signup and view all the answers

Which medication can be used in the treatment of Paroxysmal Supraventricular Tachycardia to try simple measures like Valsalva maneuver or cough?

Adenosine Signup and view all the answers

Which health issue may trigger Paroxysmal Supraventricular Tachycardia (PSVT) according to the text?

Mitral valve prolapse Signup and view all the answers

What is the hallmark characteristic of Paroxysmal Supraventricular Tachycardia (PSVT) according to the provided information?

Rate >150/min Signup and view all the answers

In Paroxysmal Supraventricular Tachycardia (PSVT), what should be considered for new onset cases?

Evaluation by an electrophysiologist if available Signup and view all the answers

What is the primary benefit of recording a rhythm strip after capturing abnormal rhythms on a 12-lead ECG?

To evaluate the heart's electrical activity over an extended period of time Signup and view all the answers

Which finding on a 12-lead ECG may indicate the presence of intraventricular conduction delay?

Widened PR interval Signup and view all the answers

What is the significance of correcting the QT interval for rate in an ECG report?

It provides a more accurate measurement for assessing arrhythmias Signup and view all the answers

When evaluating an ECG, what finding may suggest the presence of preexcitation syndromes like WPW syndrome?

Shortened PR interval Signup and view all the answers

What is the primary purpose of performing electrophysiological studies (EP studies) as mentioned in the text?

To identify patients at risk for sudden cardiac death Signup and view all the answers

When is carotid sinus massage and Valsalva maneuvers used as mentioned in the text?

To terminate atrioventricular nodal reentry tachycardia (AVNRT) Signup and view all the answers

What does Transesophageal Echocardiography (TEE) help determine as mentioned in the text?

Presence of intracardiac thrombus Signup and view all the answers

What is the purpose of evaluating extra electrical pathways using EP studies in patients with suspected congenital heart defects?

To determine if ablation is appropriate Signup and view all the answers

In what scenario would Valsalva maneuvers and carotid sinus massage NOT be recommended?

When monitoring and resuscitation equipment are not available Signup and view all the answers

How do Valsalva maneuvers and carotid sinus massage help in diagnosing arrhythmias according to the text?

They enable identification of underlying rhythms Signup and view all the answers

What is the primary purpose of using a Holter monitor in evaluating arrhythmias?

To capture arrhythmias that may not show up on a one-time ECG Signup and view all the answers

Which test is included in laboratory (serum testing) to detect hypoglycemia as a potential cause of arrhythmias?

Blood glucose measurement Signup and view all the answers

Why is 2D echocardiography with Doppler recommended during the initial workup of arrhythmia patients?

To determine atrial and ventricular size and function Signup and view all the answers

Which imaging test is useful to identify structural diseases like heart failure as potential causes of arrhythmias?

Chest radiography Signup and view all the answers

What is the benefit of using smartphone-based technology for monitoring arrhythmias?

To record continuous ECGs Signup and view all the answers

What is the purpose of stress testing in diagnosing palpitations?

To provoke electrocardiographic changes Signup and view all the answers

Why is it important to perform laboratory tests to evaluate serum electrolyte values in arrhythmia patients?

To detect disturbances like hypokalemia or hyperkalemia Signup and view all the answers

Why is it recommended to encourage patients undergoing Holter monitoring to continue routine activities?

To avoid missing arrhythmic events Signup and view all the answers

What is the significance of measuring a toxicity level in patients who might develop arrhythmias?

To monitor drug reactions Signup and view all the answers

Why should exercise stress testing be performed in diagnosing palpitations?

To provoke electrocardiographic changes Signup and view all the answers

In what way does smartphone technology impact arrhythmia monitoring?

It enables continuous ECG recording. Signup and view all the answers

What is the primary purpose of the smartphone-based ECG monitors mentioned in the text?

To provide surveillance for long-term intermittent monitoring Signup and view all the answers

What is the main difference between patient-activated electrocardiographic event recorders and auto-triggered event recorders?

Patient-activated recorders can detect asymptomatic episodes Signup and view all the answers

What distinguishes an implantable loop recorder from external event recorders?

Implantable recorders have automatic arrhythmia detection Signup and view all the answers

Which professional is typically responsible for performing tilt-table tests mentioned in the text?

Cardiologist or Electrophysiology Cardiologist Signup and view all the answers

What type of arrhythmias usually warrant referral to a specialist for electrophysiologic studies?

Arrhythmias at high risk for adverse events Signup and view all the answers

When is an external event recorder more suitable than an implantable loop recorder?

For patients with infrequent symptoms Signup and view all the answers

Why might a patient undergo a tilt-table test according to the text?

To evaluate the cause of syncope Signup and view all the answers

What distinguishes the diagnosis process between patient-activated and auto-triggered event recorders?

'Patient-activated recorders assess relation to symptoms' Signup and view all the answers

Which diagnostic procedure is primarily used to evaluate ischemic coronary artery disease or confirm the diagnosis in intermittent arrhythmias?

Electrocardiography Signup and view all the answers

What is the primary purpose of the ankle-brachial index (ABI) test?

Screen and diagnose peripheral artery disease (PAD) Signup and view all the answers

Where does the myocardium receive its blood supply from?

Coronary arteries branching from the aorta Signup and view all the answers

Which process refers to the buildup of plaque in blood vessels and can affect critical arteries like coronary, cerebral vascular, renal, and peripheral arteries?

Atherosclerosis Signup and view all the answers

What is the leading cause of death in industrialized societies?

Ischemic Heart Disease Signup and view all the answers

Which group is less likely to experience pain but more likely to present with shortness of breath and other symptoms related to coronary artery disease?

Diabetic patients Signup and view all the answers

What is the primary purpose of an electrocardiogram (ECG)?

Evaluate electrical activity of the heart Signup and view all the answers

Which procedure is essential for an accurate ECG?

Correct lead placement Signup and view all the answers

What does a normal ECG result NOT rule out?

Coronary artery disease Signup and view all the answers

What precaution is important for accurate ECG findings?

Correct lead placement Signup and view all the answers

"Female patients often present with gastrointestinal symptoms in the presence of myocardial ischemia". What kind of symptoms might these be?

Nausea and vomiting Signup and view all the answers

In Holter monitoring, what is the primary purpose of documenting abnormal cardiac electrical behavior?

To track arrhythmias in ambulatory patients Signup and view all the answers

During ECG interpretation, what should be done if an arrhythmia is suspected?

Obtain a rhythm strip (lead II) Signup and view all the answers

What is a key consideration for accurate interpretation of computer-aided ECG results?

Validation by a trained ECG expert Signup and view all the answers

What is the main procedure code for routine ECG with at least 12 leads, including interpretation and report?

93000 Signup and view all the answers

What is the primary purpose of continuous Holter monitoring?

To identify episodes of abnormal cardiac electrical behavior Signup and view all the answers

Which ECG lead placement corresponds to the left fifth intercostal space at the midclavicular line?

V4 Signup and view all the answers

During ECG recording, what is crucial to ensure to eliminate erroneous tracings?

Ground the machine properly Signup and view all the answers

What instructions should be followed when recording a 12-lead ECG or rhythm strip?

'Record according to manufacturer's instructions' Signup and view all the answers

What should be done before removing the leads when checking the adequacy of tracing in an ECG?

Ensure the machine is grounded properly Signup and view all the answers

What is the primary cause of peripheral arterial disease (PAD) as mentioned in the text?

Atherosclerosis Signup and view all the answers

What is the purpose of the ankle-brachial index (ABI) measurement?

To screen for lower extremity PAD Signup and view all the answers

In the ankle-brachial index (ABI) measurement, how is the result reported?

As a ratio with ankle systolic pressure in the denominator Signup and view all the answers

What does a lower ankle-brachial index (ABI) value in a patient indicate?

Presence of peripheral arterial insufficiency Signup and view all the answers

Which statement is true about patients who have peripheral arterial disease (PAD) according to the text?

PAD patients usually have plaque disease in various arteries of the body Signup and view all the answers

What should be done with the lower of the two ankle-brachial index (ABI) values obtained for a patient?

Record it in the patient's results Signup and view all the answers

What is one instruction given to patients undergoing an ankle-brachial index (ABI) test?

Avoid magnets and metal detectors Signup and view all the answers

How are arterial plaques primarily described in relation to peripheral arterial disease (PAD)?

Obstruct normal arterial blood flow to extremities Signup and view all the answers

What is recommended if significant abnormalities are found on a Holter monitor recording?

Referral to a cardiologist Signup and view all the answers

What can be concluded from the instruction to 'avoid getting electrodes or Holter monitor wet'?

Wet electrodes can interfere with monitoring results Signup and view all the answers

What is a crucial indication for ambulatory electrocardiography, as mentioned in the text?

Monitoring patients with acute ischemia symptoms Signup and view all the answers

What is a precaution that should be taken before performing ambulatory electrocardiography?

Considering the cost implications of the test Signup and view all the answers

What is the primary reason for instructing the patient not to shower or bathe during the 24-hour monitor use?

To maintain the integrity of the monitor Signup and view all the answers

What equipment is essential for performing Holter monitoring?

Holter monitor with new batteries Signup and view all the answers

What is the correct order of steps for preparing a patient for Holter monitoring?

Prepare skin, position patient, apply electrodes, attach cables Signup and view all the answers

What action should be taken after placing the monitor on the patient for Holter monitoring?

Give the patient a diary to record symptoms and activities Signup and view all the answers

What is necessary before interpreting Holter monitoring results?

Obtaining a specialist's review and interpretation Signup and view all the answers

Which organ accumulates amiodarone due to its long half-life?

Liver Signup and view all the answers

What is advised in cases of strong emotional reactions during Holter monitoring?

Document emotional reactions and fears experienced by the patient Signup and view all the answers

What may be responsible for causing heart blocks even when the heart is structurally normal?

Electrical disturbances in conduction pathways Signup and view all the answers

Why should cost be considered when ordering ambulatory electrocardiography?

To prevent unnecessary financial burden on patients Signup and view all the answers

How long should a patient typically wear a Holter monitor for continuous recording?

24 hours continuously Signup and view all the answers

What is a contraindication for performing Ankle-Brachial Index (ABI) testing?

Acute deep vein thrombophlebitis Signup and view all the answers

Why might ABI testing fail to detect major calf vein thrombosis in some patients?

Because of obese legs or extensive leg swelling Signup and view all the answers

What symptom is characteristic of severe Peripheral Arterial Disease (PAD) when the limbs are elevated?

Resting limb pain Signup and view all the answers

Why is a cold room unsuitable for performing ABI testing?

Results in vasoconstriction Signup and view all the answers

What is a characteristic finding in the physical examination of PAD patients' feet?

Presence of xanthomas Signup and view all the answers

Why do approximately 12% of individuals have a congenital absence of a dorsal pedal pulse?

As a normal physiological variation Signup and view all the answers

How does placing the patient's feet hanging down assist in the assessment of PAD?

To observe color return to the skin Signup and view all the answers

Why is it important to alternately dorsiflex and plantarflex both feet during examination?

To aid blood return to the limbs Signup and view all the answers

What could be a limitation of using Doppler ultrasound in patients with extensive leg swelling?

Difficulty in obtaining pulse signals Signup and view all the answers

In patients with calcified vessels due to diabetes, which vascular diagnostic testing could be performed instead of ABI testing?

Duplex sonography Signup and view all the answers

What is the correct procedure for applying the Doppler probe during ABI testing?

Aim it directly along the direction of blood flow Signup and view all the answers

What is the correct range for an ABI value to be considered normal?

0.91 to 0.99 Signup and view all the answers

What action should be taken if the ankle pressure is less than the brachial systolic pressure by 30 mm Hg or more?

Consider referral to a vascular surgeon Signup and view all the answers

What is the primary recommendation for patients with documented venous insufficiency postprocedure?

Use support stockings Signup and view all the answers

Why is it important to insist on control of hypertension in patients with atrial fibrillation?

To reduce overall cardiovascular mortality rates Signup and view all the answers

What is the purpose of measuring both dorsalis pedis and posterior tibial artery pressures in each leg?

To calculate the ABI Signup and view all the answers

What characterizes an ABI value greater than 1.40?

Noncompressible with severely calcified vessels Signup and view all the answers

What is the recommendation for encouraging gentle exercise in patients with documented arterial insufficiency?

Engage in daily walking Signup and view all the answers

Why is it suggested to instruct patients with venous insufficiency to keep their legs elevated whenever possible?

To reduce swelling and discomfort Signup and view all the answers

Study Notes

Cardiac Arrhythmias

Immediate referral to cardiology is not indicated for patients with cardiac arrhythmias who have a stable hemodynamic status and are asymptomatic.

Bradyarrhythmias

Classification is based on heart rate, with bradyarrhythmias defined as a heart rate < 60 beats/min.
Bradyarrhythmias can be further classified as sinus bradycardia, atrioventricular (AV) block, or junctional bradycardia.

Multifocal Arrhythmia

Distinguished from unifocal arrhythmia by its origin from multiple ectopic foci.

Premature Ventricular Contraction (PVC)

Typically followed by a compensatory pause in the cardiac rhythm.

Atrial Fibrillation (AF)

Main therapeutic goal in long-term treatment is to prevent stroke and reduce symptoms.
INR range for warfarin dose titration is 2.0-3.0.
One drawback of using warfarin is the risk of bleeding.
Catheter ablation is preferred over antiarrhythmic agents due to its higher success rate and lower risk of proarrhythmia.

Wide-Complex PSVT

Preferred agents for management are those that increase the refractoriness of the bypass tract, such as verapamil and diltiazem.

Risk Factor Modification

Emphasizes the importance of modifying risk factors, such as hypertension, diabetes, and smoking, in the management of AF.

AV Block

Second-degree AV block Mobitz type I is characterized by a progressive lengthening of the PR interval as the rhythm progresses.
Second-degree AV block Mobitz type II is characterized by a constant PR interval.
Third-degree AV block, also known as complete heart block, is characterized by a complete lack of conduction between the atria and ventricles.

Bundle Branch Block

Left bundle branch block (LBBB) is characterized by a QRS duration > 120 ms and a characteristic pattern on the ECG.
Complete right bundle branch block is characterized by a QRS duration of 140-160 ms.
Left posterior hemiblock is characterized by a QRS duration of 100-120 ms and a characteristic pattern on the ECG.

Hemodynamics

The effect of an arrhythmia on hemodynamics is determined by the heart rate, cardiac output, and peripheral vascular resistance.

Management of Cardiac Arrhythmias

First priority is to assess the hemodynamic status of the patient.
Nonpharmacological management includes lifestyle modifications, such as exercise and stress reduction.
Pharmacological management includes the use of antiarrhythmic medications, such as beta-blockers and calcium channel blockers.

Antiarrhythmic Medications

Classification systems include the Vaughan-Williams classification, which categorizes medications based on their mechanism of action.
Sotalol is a class III antiarrhythmic medication that is used to maintain sinus rhythm in patients with AF.
Amiodarone is a class III antiarrhythmic medication that is used to treat AF and ventricular arrhythmias.
Dronedarone is a class III antiarrhythmic medication that is used to treat AF and atrial flutter.

Proarrhythmia

Refers to the potential of antiarrhythmic medications to cause new or worsening arrhythmias.

Interprofessional Collaborative Management

Emphasizes the importance of collaboration between healthcare professionals, including cardiologists, electrophysiologists, and primary care physicians.

Catheter Ablation

A procedure used to treat AF, atrial flutter, and ventricular arrhythmias by destroying the abnormal electrical pathways in the heart.

Warfarin

An oral anticoagulant that is used to prevent stroke in patients with AF.
INR range for warfarin dose titration is 2.0-3.0.
One drawback of using warfarin is the risk of bleeding.

Dabigatran

A direct oral anticoagulant that is used to prevent stroke in patients with AF.
Approved antidote for patients who develop uncontrollable bleeding while taking dabigatran.
Contraindicated in patients with mechanical heart valves.

Idarucizumab

The approved antidote for patients who develop uncontrollable bleeding while taking dabigatran.

Cardioversion

A procedure used to restore a normal heart rhythm in patients with AF.
Electrical cardioversion is a procedure that uses electrical shocks to restore a normal heart rhythm.
Pharmacologic cardioversion is a procedure that uses medications to restore a normal heart rhythm.

Rate Control

The primary goal of rate control is to reduce the heart rate to a normal range (< 100 beats/min) in patients with AF.
Beta-blockers and calcium channel blockers are commonly used medications for rate control.
The RACE II study showed that lenient heart rate control is noninferior to strict rate control without causing adverse outcomes.

Restoration of Sinus Rhythm

The primary reason for choosing restoration of sinus rhythm in AF patients is to improve symptoms and quality of life.
Catheter ablation is a preferred method for restoring sinus rhythm due to its higher success rate and lower risk of proarrhythmia.

Rhythm Control

The primary goal of rhythm control is to restore a normal heart rhythm in patients with AF.
Factors that play a major role in determining the effect of an arrhythmia on hemodynamics include heart rate, cardiac output, and peripheral vascular resistance.

Ablation of the Atrioventricular Node/His Bundle

A procedure used to control ventricular rate in patients with AF who are refractory to medications.
Risks associated with this procedure include the need for a permanent pacemaker and the potential for proarrhythmia.

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Description

This quiz covers the overview of antiarrhythmic medications including amiodarone, dronedarone, sotalol, dofetilide, flecainide, propafenone, quinidine, and disopyramide. It also discusses the precautions and interactions associated with these medications.