questions 3

Atrial Arrhythmias

Topic updated on 03/31/15 11:14am

Atrial Fibrillation
  • Introduction 
    • atria beat at 350-600 bpm with chaotic and erratic baseline (irregularly irregular)
    • can cause atrial stasis resulting in thrombus formation
      • may lead to stroke 
    • AV nodal refractory period determines ventricular rate 
  • Presentation
    • EKG
      • no discrete P waves 
      • irregularly spaced QRS complexes
  • Treatment
    • rate control: β-blocker or calcium channel blocker
    • prevention of stroke: warfarin or aspirin as prophylaxis against thromboembolism
      • decision to anticoagulate usually determined using CHADS2 score
Atrial Flutter
  • Introduction
    • atria beat at 180-350 bpm with identical, back-to-back atrial depolarization waves
  • Presentation
    • EKG
      • the identical "sawtooth" flutter P-waves
  • Treatment
    • convert to sinus rhythm
    • class IA, IC, or III antiarrhythmics 


Qbank (3 Questions)

(M1.CV.21) A 60-year-old male with a past medical history of congestive heart failure presents to his cardiologist with complaints of dyspnea on exertion and palpitations. The EKG strip is shown below. Which of the following is most likely to be spared of infarction? Topic Review Topic
FIGURES: A          

1. Heart
2. Cerebral cortex
3. Kidney
4. Liver
5. Spleen

(M1.CV.41) A 28-year-old woman presents to the urgent care center complaining of weakness, confusion, and that her heart is "racing and flopping" in her chest. She has no significant past medical history. She denies any previous episodes of anxiety attacks or heart issues. She smokes 1/2 of a pack of cigarettes per day and is a social drinker. She denies the use of any illicit drugs. She has no known drug allergies, and she does not take any medications on a daily basis. An EKG is ordered and is shown in Figure A. This patient's ventricular contraction rate is determined by which of the following? Topic Review Topic
FIGURES: A          

1. SA node refractory period
2. AV node refractory period
3. Bundle of His conduction speed
4. Purkinje fiber conduction speed
5. Purkinje fiber refractory period

(M1.CV.203) A 60-year-old male presents with palpitations. He reports drinking many glasses of wine over several hours at a family wedding the previous evening. An EKG reveals absent P waves and irregularly irregular rhythm. He does not take any medications. Which is most likely responsible for the patient’s symptoms? Topic Review Topic

1. Atrial fibrillation
2. Transmural myocardial infarction
3. Untreated hypertension
4. Torsades de pointes
5. Ventricular hypertrophy


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