Term
| uncoagulated atrial fibrillation have an annual embolic rate of ____% and a lifetime risk of ____% |
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Definition
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Term
| cardioversion of AF to sinus carries ____-____% risk of embolism |
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Definition
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Term
| synchronized cardioversion at ______-______ joules for AF |
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Definition
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Term
| AF longer than 48 hours needs to heparinized, how much? |
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Definition
| 80 units/kg IV followed by infusion of 18 units/kg/hr before cardioversion |
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Term
| control the rate in atrial fibrillation with what medication? |
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Definition
dilitiazim 20 mg IV over 2 min (0.25 mg/kg)
if the patient has impaired cardiac function, use Amiodarone (5 mg/kg IV over 30 min) or Digoxin (0.4-0.6 mg IV) |
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Term
| What is the first line of tx in SVT? what is the first line of med? |
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Definition
valsalva manuevers, carotid massage
adenosine (6 mg rapid IV bolus, followed by rapid flush, give 2nd dose of 12 mg IV if needed) |
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Term
| In a patient with narrow complex SVT and normal cardiac function, cardioversion may be achieved with second line agents. name three |
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Definition
1. CCBs: diltiazim 20 mg IV over 2 min
2. BBs: metoprolol 5 mg IV
3. digoxin: 0.4-0.6 mg IV |
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Term
| How do you treat VT in a stable and an unstable pt? |
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Definition
-unstable: unsynchronized cardioversion 200-260 J
-stable: amiodorone 150 mg over 10 mins |
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Term
| V-fib: cardioversion parameters and meds |
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Definition
-unsynchronized defibrillation at 200, then 300, then 360
-epi 1 mg IV push, 20 mL saline flush, Q 3-5 min
-amiodarone 300 mg IV push
-mag sulfate 2 g IV |
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Term
| What is the tx for ACS/MI? Think of the acronym |
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Definition
MONA
morphine sulfate: 2-10 mg IV given in 2-4 mg increments
o2: 10-15 L
NG: 0.4 mg tab SL repeated 3 x Q 3-5 min
Aspirin: 160-325 mg chewed |
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Term
| What are three other meds used in the tx of ACS/MI besides MONA |
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Definition
-BB: metorpolol 5 mg IV over 1 min, can be repeated twice, MAX 15 mg
-Heparin
-TPA |
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Term
| All patients with AMI especially with CHF and systolic BP>100 within 24 hours need to be given what? |
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Definition
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Term
| Clopidogrel is given to ACS/MI patients in what case? |
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Definition
ASA allergy
300 my PO then 75 mg/day |
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Term
| what are the normal ranges for pH, PaCO2, and HCO3 for ABGs? |
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Definition
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Term
| what leads on an EKG are atrial fib and sinus tach best seen in? |
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Definition
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Term
| what are the 5 stages of CHF? what is the difference between compensated and decompensated CHF? |
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Definition
-normal-asymptomatic LV dysfunction-compensated CHF-decompensated CHF- refractory CHF
-in compensated: the sx are controlled by medical therapy
-in decompensated: sx persist despite usual therapy and are refractory to adjustments in drugs and dosages |
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Term
| what is an acronym for the sx of HF? |
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Definition
FACES
-fatigue
-activity decrease
-cough (esp supine)
-edema
-shortness of breath |
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Term
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Definition
-brain natriuretic peptide: produced in ventricles in response to volume and pressure overload
-atrial natriuretic peptide: produced in atria in response to wall stress |
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Term
| what are three things that higher levels of BNP are associated with? what are the levels to know |
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Definition
-higher PCW pressures (in compensated and decompensated patients)
-larger LV volumes
-lower ejection fractions (in symptomatic HF patients)
->400 acute CHF is present |
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Term
| What is one of the first things to measure when considering CHF as a dx, what are the levels to know? |
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Definition
LV ejection fraction
-< or equal to 40%= systolic dysfunction
-40-55%= mixed
-> or equal to 55%- diastolic dysfunction |
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Term
| What does an echocardiogram tell you? and EKG? |
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Definition
echo- checks valves and blood flow through the heart
ekg- heart's electrical impulses |
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Term
| in CHF, what is the different tx protocols if a pt has fluid retention and if they do not? |
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Definition
-fluid retention: loop diuretic (+/- thiazide) and add dig for sx control
-no fluid retention: ACE (or ARB if can't take ACE), BB, spironolactone |
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Term
| what is the dosage for furosemide in CHF? titrate to what? |
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Definition
-20-80 mg QD-BID
titrate to euvolemic state |
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Term
| what is the dosage of digoxin in HF? |
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Definition
| 0.125-0.25 mg (lower in elderly: 0.0625 mg) |
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Term
| what are the cornerstone of RX in CHF? |
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Definition
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Term
| What are some contraindications to starting a HF pt on a BB? |
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Definition
-bronchospastic pulm dz
-severe bradycardia, high degree AV block, sick sinus syndrome
-congestive sx at rest
-IV tx for HF
-hospitalized pt
-unstable sx |
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Term
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Definition
| resynchronization/defibrillation for advanced heart failure trial |
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Term
| What are the 4 DeBakey classifications of aortic dissections? I,II,III,IIIB |
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Definition
I= ascending aorta extending beyond arch
II= ascending aorta only
III= descending aorta
IIIb= descending aorta extending below the diaphragm |
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