Cardiovascular/Pulmonary: Case 9

Course Information Year 2 Courses: Cardiovascular & Pulmonary

Path Labs

Harvi

Foundation

Guidelines

Auscultation

D. Winkleman and A. Fall

Weeks 7

• Weekly Objectives - Week 7

Boards and Beyond

List of Boards and Beyond Videos along with length

Note: If you are logged into Board and Beyond, these links should go directly to the video.

This Week: 169 minutes

• Cardiac Action Potentials - Boards and Beyond

  • Video

  16 minutes

• AV and Bundle Branch Blocks - Boards and Beyond

  • Video

  29 minutes

• Atrial Fibrillation and Flutter - Boards and Beyond

  • Video

  22 minutes

• AVNRT - Boards and Beyond

  • Video

  9 minutes

• WPW - Boards and Beyond

  • Video

  9 minutes

• Antiarrythmic Drugs - Boards and Beyond

  • Video

  45 minutes

• Heart Murmurs - Boards and Beyond

  • Video

  22 minutes
  Also listed on Case 5

• Heart Sounds -Boards and Beyond

  • Video

  17 minutes
  Also listed on Case 5

Required

• 10-25 Disorders of Rate & Rhythm IN: Current Medical Diagnosis & Treatment

• 10-26 Mechanisms of Arrhythmias IN: Current Medical Diagnosis & Treatment

• 10-27 Techniques for Evaluating Rhythm Disturbances IN: Current Medical Diagnosis & Treatment

• 10-28 Sinus Arrhythmia, Bradycardia, & Tachycardia IN: Current Medical Diagnosis & Treatment

• 10-29 Atrioventricular Block IN: Current Medical Diagnosis & Treatment

• 10-30 Paroxysmal Supraventricular Tachycardia (PSVT) IN: Current Medical Diagnosis & Treatment

• 10-31 PSVT Due to Accessory AV Pathways (Preexictation Syndrome) IN: Current Medical Diagnosis & Treatment

• 10-32 Atrial Fibrillation IN: Current Medical Diagnosis & Treatment

• 10-33 Atrial Flutter IN: Current Medical Diagnosis & Treatment

• 10-34 Atrial Tachycardia IN: Current Medical Diagnosis & Treatment

• 10-35 Ventricular Premature Beats (Ventricular Extrasystoles) IN: Current Medical Diagnosis & Treatment

• 10-36 Ventricular Tachycardia IN: Current Medical Diagnosis & Treatment

• 10-37 Ventricular Fibrillation & Sudden Death IN: Current Medical Diagnosis & Treatment

• 10-38 Inherited Arrhythmia Syndromes IN: Current Medical Diagnosis & Treatment

• 10-39 Syncope IN: Current Medical Diagnosis & Treatment

Required 19

• Management of Patients on Non-Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting

  Recent review of new oral anticoagulants
  Also on Case 6
  --Read introduction, Pharmacology of NOACS, laboratory measurement, and NOAC reversal.
  --(Pages E1-E8) Review Table 1 & Figure 1
  --Rest of article is for reference as needed in the future.

  more… less…

  Raval AN, Cigarroa JE, Chung MK, Diaz-Sandoval LJ, Diercks D,et al. Management of Patients on Non-Vitamin K Antagonist Oral Anticoagulants
  in the Acute Care and Periprocedural Setting: A Scientific Statement From the
  American Heart Association. Circulation. 2017 Mar 7;135(10):e604-e633. doi:
  10.1161/CIR.0000000000000477.

• Heart Failure with Preserved Ejection Fraction

  Read introduction and then understand the mechanisms by which heart failure with preserved ejection fraction leads to atrial fibrillation.
  Review Figure #3

  more… less…

  Redfield MM. Heart Failure with Preserved Ejection Fraction. N Engl J Med. 2016 Nov 10;375(19):1868-1877.

Supplementary Harrison’s Pathophysiology Videos

Short animations from Harrison’s

Total Time: 4 min 44 sec

• Pathogenesis of Stroke in Atrial Fibrillation - Harrison’s Pathophysiology Animations

  • Video

  1 min 25 sec

• Stroke Risk Assessment in Patients with Atrial Fibrillation - Harrison’s Pathophysiology Animations

  • Video

  3 min 19 sec

Enrichment 19

• What Surgeons Should Know About Non-Vitamin K Oral Anticoagulants

  Excellent reference summary about the new non-Vitamin K anticoagulants and their management when bleeding risk procedures are planned.

  more… less…

  Verma A, Ha ACT, Rutka JT, Verma S. What Surgeons Should Know About Non-Vitamin K Oral Anticoagulants: A Review. JAMA Surg. 2018 Jun 1;153(6):577-585. doi: 10.1001/jamasurg.2018.0374.

• ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities

  Look up indicators for pacemaker for pediatric/congenital cases. (pg 26-28)
  Also on Guidelines

  more… less…

  Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, et al. 2012
  ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines
  for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2013 Jan 22;61(3):e6-75. doi: 10.1016/j.jacc.2012.11.007.

• 2019 AHA/ACC/HRS Focused Update of the 2014 Guideline for Management of Patients with Atrial Fibrillation

  more… less…

  January CT, Wann LS, Calkins H, Field ME, Chen LY, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019 Jan 21. pii: S0735-1097(19)30209-8. doi: 10.1016/j.jacc.2019.01.011.

• 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation

  You can assess the risks associated with atrial fibrillation using the CHAD score – see page e17 – Major value from guideline document is the good summary of rate control strategies and basic management on 5 pages: e27-e31
  2019 Focused update linked in Guidelines section

  more… less…

  January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014 Dec 2;64(21):e1-76. doi:10.1016/j.jacc.2014.03.022.

Weekly Objectives

Cardiac arrhythmias, Atrial fibrillation, and Heart Blocks

Cardiac Arrhythmias

1. Describe the anatomy and physiology of cardiac electrical system and explain how excitation-contraction coupling results in cardiac performance.
2. Describe how systolic murmurs are graded on a 1-6 Levine scale.
3. Review the ionic basis of electrical activation of pacemaker cells and myocytes.
4. Describe the mechanism of common arrhythmias, including bradycardias and tachycardias.
5. Integrate the basics of ECG interpretation for use in diagnosing arrhythmias.
6. Explain the mechanism by which antiarrhythmic drugs can help in the prevention or termination of arrhythmias.
7. Recognize the potential role for device-based and ablation-based therapies for arrhythmias.

Atrial Fibrillation

1. Diagram and explain the relationship between the electrical conduction system and the cardiac cycle.
2. List the serum biomarkers used to assess myocardial tissue injury.
3. Describe the pharmacological mechanisms and rationale for using : Coumadin versus novel oral anticoagulants, metoprolol and other beta blockers, amiodarone and other antiarrythmics; ACE inhibitors, ARBs, and Calcium channel blockers.

Heart Blocks

1. Explain the etiology of bradyarrhythmia’s.
2. Describe how patients adapt to bradyarrhytmia’s and heart block.
3. Describe the clinical presentation of complete heart block.
4. Define sinus bradycardia.
5. Identify potential causes of bradycardia.
6. Describe reversible causes of complete heart block.
7. Describe the National Heart, Lung and Blood Institute’s criteria for first, second and third degree heart blocks.
8. Characterize the differences in ECG patterns related to various types of heart blocks.
9. Explain the pharmacology of new oral anticoagulants.
10. Differentiate the types of pacemakers used, and describe the paced ECG.

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Source:
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Captured on May 5, 2021