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Cardiology

Question
44 out of 57
 

What is the drug of choice to control supraventricular tachycardia:



A Adenosine
B Propranolol

C Verapamil
D Digoxin

Ans. A

Adenosine

SVT

1. SVT.Narrow complex tachycardia (rate> l00bpm, QRS width <120ms),

2. Acute management:Vagotonic maneuvers followed by IV adenosine, esmolol or verapamil

(if not on B-blocker); DC shock if hemodynamically compromised.

3. Maintenance therapy:B-blockers or verapamil.

Atrial flutter

ECG: continuous atrial depolarization (eg -300/min, but very variable) produces a sawtooth appearance

2: 1 AV block Q.

Carotid sinus massage Qand IV adenosine Q transiently block the AV node and may unmask flutter waves.

Treatment of Atrial flutter

1. Control ventricular rate with digoxin Q

2. Alternatives: Verapamil, Beta-blocker, or amiodarone Flecainide Q

3. DC shock Q if hemodynamically compromised.

4. Finally, permanent pacing Q may be used to overdrive tachyarrhythmias, to treat

5. Atrial flutter with 2:1 AV bradyarrhythmias, or prophylactically in conduction disturbances

6. Implanted automatic defibrillators can save lives.

PSVT- adenosine, esmolol or verapamil Q

Extra Edge:There are only two conditions where digoxin is absolutely contraindicated. The first one WPW syndrome and other is HOCM!!!

Atrial fibrillation (Af) (Ref. Hari 18th Pg-1881)

Extra Edge:

1. Af is a chaotic, irregular atrial discharge ratio is at 450-600 bpm; the AV node responds intermittently, hence an irregular ventricular rate.

2. Cardiac output drops by 20% -30%.

3. Af is common in the elderly.

4. The main risk is embolic stroke Q.

5. Warfarin reduces this.

6. Causes

There are 4 main causes:

1. CAD

2. HT

3. RHD

4. Hyperthyroid

Others:CHF, ASD, alcohol, Tea, Coffee, Congenital

SymptomsMay be asymptomatic or cause chest pain, palpitations Q, dyspnoea, or faintness Q.

Signs: Irregularly irregular pulse Q, the apical pulse rate is greater than the radial rate Q and the heart sound is of variable intensity Q .

Tests ECG shows absent P waves Q, irregular QRS complexes Q.

Treatment:

For acute control of Af:

1. Injection verapamil

2. Beta blocker

3. Injection IBUTILIDE

4. Synchronize DC shock of 50 to 100 Joules.

Treatment of chronic Af

1. Beta-blocker.

2. Alternative if LV dysfunction used amiodarone Q

3. Use anticoagulant till INR more than 1.8.

4. If fails and no LV dysfunction used sotalol Q.

5. Digoxin in RHD

6. Surgical treatment of Af = MAZE procedure.

Ventricular extrasystoles (ectopic) are the commonest Q post-MI arrhythmia.

1. They are also seen in healthy people

2. Post-MI they suggest electric instability, and there is a risk of VF if the R on T pattern (ie no gap before the T wave) is seen.

3. If frequent (> 10/min), give amiodarone.

VT:

VT Broad complex tachycardia (rate >100 bpm, QRS duration >0.12 sQ)

Acute management IV lidocaine Q (= Lignocaine), or amiodarone Q IV, if no response than give DC shock Q.

1. Amiodarone Q 300mg IV over 20-60min, then 900mg over 24hr or

2. Lidocaine Q 50mg over 2min repeated every 5min to 200mg max.

3. If this fails, or if cardiac arrest, use DC shock Q.

4. After correction of VT, establish the cause from history/ investigations.

If VT occurs >24h after MI, give IV lidocaine infusion Q and start oral antiarrhythmic: eg amiodaroneQ.

Prevention of recurrent VT:Surgical isolation of the arrhythmogenic area or implantation of tiny automatic defibrillators may help.

Ventricular fibrillation(VF): Useasynchronized DC shock Q

Cardiology Flashcard List

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