By Bimal Ashar MD MBA, Redonda Miller MD MBA, Stephen Sisson MD, Johns Hopkins Hospital
Don't gamble at the most crucial examination of your career... ace the forums with The Johns Hopkins inner medication Board Review! dropped at you from the birthplace of inner drugs and thought of as the most popular evaluate instrument within the specialty, it is going to ascertain you are as built as attainable in your technique to certification or recertification. From internists to primary care physicians, this no-nonsense book is a must have spouse for everybody within the box.
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Additional resources for The Johns Hopkins Internal Medicine Board Review: Certification and Recertification
Treatment options for arrhythmias vary depending on the underlying cause and may encompass pharmacotherapy, electrical conversion, pacemaker or defibrillator insertion, or catheter or surgical ablation. ■ ■ ■ ■ Device types: Dual-chamber pacemaker (DDD, senses and paces right atrium and ventricle), unless permanent atrial fibrillation is present, in which case single-chamber ventricular (VVI) pacing is most appropriate ■ Biventricular pacemaker, which provides cardiac resynchronization therapy (CRT), increasingly used for patients with chronic systolic heart failure (ejection fraction [EF] 50% or less) who require frequent ventricular pacing ■ Supraventricular Tachyarrhythmias (SVTs) AV NODAL REENTRANT TACHYCARDIA (AVNRT) Basic Information (Table 5-3) ■ Indications: ■ Sinus node dysfunction and Mobitz I seconddegree AV block in the presence of symptoms that correlate with the bradycardia ■ Mobitz II second-degree AV block and thirddegree AV block, even when asymptomatic ■ ■ Brief, asymptomatic sinus pauses are common; permanent pacemaker therapy is generally indicated only in the presence of symptoms Atrioventricular (AV) node and His-Purkinje system First-degree AV block ■ PR interval prolongation more than 200 ms ■ Second-degree AV block ■ Mobitz I (Wenckebach): progressive PR interval prolongation followed by single blocked P wave; most common site of block is in the AV node ■ Mobitz II: No progressive PR interval prolongation before blocked P wave; most common site of block is in the His-Purkinje system ■ Third-degree (complete) AV block ■ No association between P waves and QRS complexes ■ Narrow QRS (junctional) escape rhythm: usually blocked in AV node ■ Wide QRS (ventricular) escape rhythm: suggests block in His bundle or below ■ Acute management of bradyarrhythmias (see Table 5-1) Permanent pacemaker implantation for chronic management of bradyarrhythmias ■ tt p h ■ ■ ■ /: / TREATMENT p .
Morrow DA, Boden WE. Stable ischemic heart disease. In: Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia: Elsevier; 2011:1210-1270. tt p h /: / iv p . i 4 BOARD CHAPTER 5 REVIEW Arrhythmias GRANT V. CHOW, MD; and JOSEPH E. MARINE, MD CLINICAL PRESENTATION Arrhythmias lead to significant morbidity and mortality and affect all age groups. They are classified as bradyarrhythmias or tachyarrhythmias based on heart rate. Bradyarrhythmias (heart rates <60 beats/min) can result from abnormalities at any point along the conduction path because of depressed automaticity, conduction delay, or block.
January CT, Wann LS, Alpert JS. 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;64:e1-e76. Moss AJ, Zareha W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877-883. Moya A, Sutton R, Ammirati F, et al.