N7 Tachyarrhythmias, Pacemakers, Congestive Heart Failure, and Syncope

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Cardiac Pearls

1. A patient with a rapid, regular, narrow complex tachycardia with no P waves could have any of the following dysrhythmias except:
	a.	Atrial fibrillation
	b.	Wolff-Parkinson-White (WPW) syndrome
	c.	Narrow complex ventricular tachycardia (VT)
	d.	Paroxysmal supraventricular tachycardia (PSVT)
2. Which medication is the most appropriate?
	a.	Adenocard 6mg, then 12 mg bolus; followed by verapamil if no response
	b.	Dipyridamole (Persantine), PO.
	c.	Lidocaine 75 mg; followed by verapamil if no response
	d.	Propranolol 2 mg IV
3. Which of the following cardiac abnormalities has been associated with increased incidences of supraventricular tachycardia?
	a.	Tetralogy of Fallot
	b.	Transposition of the great vessels
	c.	Epstein’s anomaly
	d.	Patent ductus arteriosus
4. A patient with an irregular narrow complex tachyarrhythmia is most likely to have what diagnosis?
	a.	Atrial fibrillation or atrial flutter with variable AV block
	b.	Complete heart block with frequent premature ventricular contractions
	c.	Sinus tachycardia
	d.	Sinus bradycardia
5. In a patient with acute atrial fibrillation with a rapid ventricular response, which drug is the first drug of choice?
	a.	digoxin
	b.	adenocard
	c.	diltiazem
	d.	magnesium
6. Which drug has the broadest usage for supraventricular and ventricular tachydysrhythmias?
	a.	Lidocaine
	b.	Bretylium
	c.	adenosine
	d.	amiodarone
7. Rare cases of brief runs of ventricular tachycardia after adenosine boluses have been reported. The most likely anatomic origin of this dysrhythmia is:
	a.	The left atrium
	b.	The right atrium
	c.	The inferior left ventricular septum
	d.	The pulmonary outflow tract
8. Even though the ACLS manual does not indicate it, this drug is 40% to 60% effective in converting stable VT.
	a.	lidocaine
	b.	magnesium
	c.	atropine
	d.	digoxin
9. Unstable WPW should be immediately treated with:
	a.	Amiodarone
	b.	Lidocaine
	c.	Electrical cardioversion
	d.	Magnesium
10. Using an NG tube and a pacer lead can provide you with an ECG called a:
	a.	NG ECG
	b.	Esophageal ECG
	c.	Retrocardiac ECG
	d.	15-lead ECG
11. A patient has an ECG showing biphasic T waves in V2 and V3. The patient is found to have a critical stenosis of the left anterior descending coronary artery. This sometimes called:
	a.	Biphasic disease
	b.	Wellen’s syndrome
	c.	Wellness disease
	d.	Widow’s lesion
12. Twiddler’s syndrome is seen in a patient with
	a.	SVT
	b.	VT
	c.	A dysfunctional pacemaker due to loose leads
	d.	Dementia
13. The patient with a pacemaker and an acute MI may present with Cabrera sign on the ECG. This is best described as:
	a.	Rabbit ears in the QRS
	b.	A U wave
	c.	Notching of the S wave in leads V2 and V3
	d.	A new bundle-branch block pattern
14. All of the following are helpful in determining VT except:
	a.	The age of the patient
	b.	Superior or marked left-axis deviation
	c.	Completely negative (QS complexes) deflections in all three limb leads I, II and III
	d.	QRS morphology identical to a previous PVC
15. In digoxin toxicity what is the drug of choice?
	a.	dioxin
	b.	digitoxin
	c.	Digibind
	d.	lidocaine
16. The patient is expected to react to Digibind within what period of time?
	a.	Immediately
	b.	Within 3 minutes
	c.	Within 30 minutes
	d.	Within 24 hours
17. What two tachyarrhythmias are almost never seen with digoxin toxicity?
	a.	VT and A-fib
	b.	A-fib with a rapid ventricular response and Mobitz II AV block
	c.	Mobitz I and II
	d.	PAT and A-fib
18. A patient asks you to look his chest x-ray to determine the status of his St. Jude’s cardiac valve. What can you tell from the x-ray?
	a.	That a radiologist would have to make that judgment
	b.	That is impossible to see a St. Jude’s valve on x-ray because they are not radio-opaque
	c.	Say all the valves look alike even when they are not functioning properly
	d.	An over-penetrated X-ray will have to be ordered to best view the valve
19. Pleural effusions are almost always on which side of the chest?
	a.	Bilaterally
	b.	Right
	c.	Left
	d.	There is no predominance
20. Which of the following is not a cardiac cause of a stroke in a young patient?
	a.	R to L shunts from a patent foramen ovale
	b.	Fossa ovalis aneurysms
	c.	Occult atrial septal defects
	d.	Athlete’s heart
21. Aminophylline has now found its use in what possible cardiac dysrhythmia treatments?
	a.	AV block and asystole
	b.	LBBB
	c.	PAT with block
	d.	Atrial fibrillation
22. In congestive heart failure, pulmonary edema is likely to occur when the pulmonary capillary wedge pressure first approaches:
	a.	12mm Hg
	b.	17mm Hg
	c.	25mm Hg
	d.	35mm Hg
23. The following is true of diastolic heart failure:
	a.	It occurs in 80% of all cases of CHF
	b.	It is more common in younger patients
	c.	It is usually caused by alcohol
	d.	No single feature of the history, physical examination, chest radiograph, or electrocardiogram reliably differentiates systolic from diastolic dysfunction
24. Using ACE inhibitors in an older adult puts the patient at risk for:
	a.	Liver failure
	b.	CHF
	c.	Renal dysfunction
	d.	Hypokalemia
25. The addition of spironolactone to selected patients’ standard CHF therapy has been found to:
	a.	Increase mortality
	b.	Reduce mortality
	c.	Have no effect upon mortality
	d.	Induce renal failure
26. All of the following agents have been found to be useful in treating diastolic heart failure except:
	a.	Nitrates
	b.	Beta blockers
	c.	Calcium channel blockers
	d.	ACE inhibitors
27. Name three causes of syncope in a patient under 35.
	a.	psychiatric, arrythmia and cardiac
	b.	psychiatric, WPW, Long QT syndrome
	c.	psychiatric, drug induced and orthostatic
	d.	psychiatric, neurocardiogenic and neurally mediated
28. Which of the following rhythms would not cause syncope?
	a.	SVT
	b.	Atrial Fibrillation
	c.	Complete AV block
	d.	Normal sinus rhythm
29. Elemental mercury has been found to be present in the myocardium in some cases of idiopathic dilated cardiomyopathy. Of the following, the most likely source of high dose mercury is:
	a.	City water
	b.	Tuna fish
	c.	Thimerosal (ethyl mercury) found in some vaccines
	d.	Air pollution near coal fire power plants.