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Dr. Ben-Zur is a cardiologist and electrophysiologist who treats various heart conditions, including tricuspid stenosis, atrial fibrillation, a-fib, AF, arrhythmias, valvular disease, congestive heart failure, and many more. He services patients from Burbank, Sherman Oaks, Encino, Hollywood and beyond.

ACLS PRE-TEST
ANNOTATED ANSWER KEY
June, 2011
Question 1:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm X Third-degree AV block
Polymorphic ventricular tachycardia
Question 2:
There is no pulse with this rhythm. Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole X Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 3:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
X Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 4:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation X Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 5:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation X Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 6:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
X Polymorphic ventricular tachycardia
Question 7:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation X Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 8:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation X Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 9:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation X Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 10:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation X Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 11:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
X Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 12:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation X Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 13:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
X Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 14:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter X Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 15:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
X Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 16:
Please identify the rhythm by selecting the best single answer
X Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 17:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
X Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 18:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia X Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 19:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter X Second-degree AC block (Mobitz I Wenckebach)
Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 20:
Please identify the rhythm by selecting the best single answer
Agonal rhythm/asystole Pulseless electrical activity
Atrial fibrillation Reentry supraventricular tachycardia
Atrial flutter Second-degree AC block (Mobitz I Wenckebach)
X Coarse ventricular fibrillation Second-degree AV block (Mobitz II block)
Fine ventricular fibrillation Sinus bradycardia
Monomorphic ventricular tachycardia Sinus tachycardia
Normal sinus rhythm Third-degree AV block
Polymorphic ventricular tachycardia
Question 21: Which of the following statements about the use of magnesium in cardiac arrest is most accurate?

Permanent Pacemaker Inse

Updated: May 21, 2014

Background

The number of permanent pacemaker insertions in the United States has been steadily increasing.[1] pacemaker is an electronic device, approximately the size of a pocket watch, that senses intrinsic heart rhythms and provides electrical stimulation when indicated.

At present, 3 approaches to permanent cardiac pacing are in common use:

  • Single-chamber pacemaker – With this device, 1 pacing lead is implanted in the right atrium or ventricle
  • Dual-chamber pacemaker – With this device, 2 pacing leads are implanted (1 in the right ventricle and 1 in the right atrium); this is the most common type of implanted pacemaker
  • Biventricular pacing (cardiac resynchronization therapy [CRT]) – With this approach, in addition to single- or dual-chamber right heart pacing leads, a lead is advanced to the coronary sinus for left ventricular epicardial pacing

The first implantable pacemaker to be used in a human being was inserted by Dr. Ake Senning in 1958; it lasted for only a few hours. Since then, cardiac pacing has evolved to include single-chamber, dual-chamber, and cardiac resynchronization devices. Epicardial lead implantation by thoracotomy has largely been replaced by transvenous placement of right atrial and right ventricular leads, as well as left ventricular epicardial pacing lead placement via the coronary sinus.

Remarkable advances have been made in pacemaker technology, including reduced size, increased battery longevity, and remote monitoring capability, as well as the addition of magnetic resonance imaging (MRI)-safe pacemakers.[2]

Published guidelines that outline indications for cardiac pacing are available from both the American Heart Association (AHA) and the European Society of Cardiology.[3, 4] This article outlines the clinical indications for pacing, implant techniques, and common pacing system complications.

Indications

Indications for pacemaker implantation are categorized into the following classes:

  • Class I – The procedure should be performed
  • Class IIa – It is reasonable to perform the procedure, but additional studies with focused objectives are needed
  • Class IIb – The procedure may be considered, but additional studies with broad objectives are needed
  • Class III – The procedure should not be performed; it is not helpful and may be harmful

In 2008, the American College of Cardiology (ACC), the AHA, and the Heart Rhythm Society (HRS) jointly published guidelines.[5] For further details on the following indications, see the ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities.

Class I indications include the following:

Class IIa indications include the following:

  • Sinus node dysfunction
  • Acquired atrioventricular block in adults
  • Chronic bifascicular block
  • Hypersensitive carotid sinus syndrome and neurocardiogenic syncope
  • Patients with congenital heart disease
  • Pacing to prevent tachycardia
  • Permanent pacemakers that automatically detect and pace to terminate tachycardia

Class IIb indications include the following:

  • Sinus node dysfunction
  • Acquired atrioventricular block in adults
  • Chronic bifascicular block
  • After acute myocardial infarction
  • Hypersensitive carotid sinus syndrome and neurocardiogenic syncope
  • After cardiac transplantation
  • Pacing to prevent tachycardia
  • Patients with congenital heart disease

Contraindications

Contraindications for permanent pacemaker insertion include the following:

  • Local infection at implantation site
  • Active systemic infection with bacteremia
  • Severe bleeding tendencies (relative contraindication)
  • Active anticoagulation therapy (relative contraindication)
  • Severe lung disease and positive end-expiratory pressure ventilation (relative contraindication for internal jugular and subclavian access)

Technical Considerations

Procedural planning

Cardiac pacing can be either temporary or permanent. Temporary pacing may be accomplished transcutaneously (ie, placing 2 external pacing pads over the chest wall in the anteroposterior or anterolateral location) or via transvenous placement of a temporary pacing wire in one or more of the right heart chambers. In a patient who has recently undergone cardiac surgery, temporary epicardial leads are often placed and removed before the patient is discharged from the hospital.[6]

Permanent pacing is most commonly accomplished through transvenous placement of leads to the endocardium (ie, right atrium or ventricle) or epicardium (ie, to the left ventricular surface via the coronary sinus), which are subsequently connected to a pacing generator placed subcutaneously in the infraclavicular region. In a patient without appropriate venous access, epicardial leads can be placed via a thoracotomy and tunneled subcutaneously to the pacing generator.

Complication prevention

Multiple studies have shown that infection rates can be reduced by employing maximal sterile-barrier precautions, including mask, cap, sterile gown, sterile gloves, and large sterile drape.

Subclavian artery injury may occur during subclavian vein access, carotid artery puncture during jugular vein access, and femoral artery puncture during femoral vein access. The subclavian artery cannot be compressed; accordingly, the subclavian approach should be avoided in anticoagulated patients.

An air embolism may be caused by negative intrathoracic pressure during inspiration by the patient, which sucks air into an open line hub. Be sure the line hubs are always occluded. Placing the patient in the Trendelenburg position lowers the risk of this complication.

If air embolism occurs, the patient should be placed in the Trendelenburg position with a left lateral decubitus tilt; this may prevent the movement of air into the right ventricle and onward into the left side of the heart. In addition, 100% oxygen should be administered to speed resorption of the air. If a catheter is located in the heart, aspiration of the air should be attempted.

Dysrhythmia is due to mechanical irritation of the heart by the wire or catheter tip. It can usually be terminated by simply withdrawing the equipment into the superior vena cava. Placing a central venous catheter without a cardiac monitor is unwise.

If the clinician is not conscientious about maintaining control of the guide wire, it may be inadvertently inserted fully into the vein and have to be retrieved.

Patients who are allergic to antibiotics may experience anaphylaxis upon insertion of an antibiotic-impregnated catheter.

Gaining just FIVE pounds around your stomach increases your blood pressure, study finds

  • Mayo Clinic study found gaining five to 11 pounds increases blood pressure
  • Researchers believe it is the first time a study has showed the link was specifically related to an increase in abdominal fat
  • Found weight gain did not affect cholesterol, insulin or blood sugar levels 

By LIZZIE PARRY FOR MAILONLINE

Gaining just five pounds can lead to an increase in blood pressure, a new study has found

Gaining just five pounds can lead to an increase in blood pressure, a new study has found

Gaining just a small amount of weight can put people at risk of raised blood pressure, a new study has found.

Researchers found people who put on just five pounds saw their blood pressure rise.

Many people are aware of the health implications of being severely overweight or obese, but scientists at the Mayo Clinic in the U.S. wanted to see the impact of small weight gain of five to 11 pounds.

Lead author Dr Naima Covassin, said: ‘To our knowledge, for the first time, we showed that the blood pressure increase was specifically related to increases in abdominal visceral fat, which is the fat inside the abdomen.

‘Our research suggests that healthy people who are more likely to gain weight in the stomach area are also more likely to have their blood pressure increased.’

At the beginning of the eight-week study, a 24-hour monitor tested the blood pressure of 16 normal weight people.

Researchers fed them an extra 400 to 1,200 calories each day with their choice of an ice cream shake, chocolate bar or energy drink to increase their weight by about five per cent.

Afterwards, their blood pressure was taken for another 24-hour period.

Their results were compared to 10 normal weight, healthy people who maintained the same weight over the eight weeks.

The researchers found those who gained weight had a systolic blood pressure (top number) increase from an average 114 mm Hg to an average 118 mm Hg.

Those who gained more weight inside their abdomen had a greater blood pressure increase.

However, a five to 11 pound weight gain did not affect cholesterol, insulin or blood sugar levels. The study was conducted in healthy people aged 18 to 48.

Dr Covassin said further studies will need to be conducted to see if the results are similar in different age groups, those with a family history of high blood pressure and other groups.

‘The public awareness of the adverse health effects of obesity is increasing; however, it seems most people are not aware of the risks of a few extra pounds,’ added Dr Covassin.

‘This is an important finding because a five to seven-pound weight gain may be normal for many during the holiday season, the first year of college or even while on vacation.’

The research was presented at the American Heart Association’s High Blood Pressure Research Scientific Sessions.

Researchers at the Mayo Clinic in the U.S. found a five to 11 pound weight gain did not affect cholesterol, insulin or blood sugar levels. Dr Naima Covassin, said: 'This is an important finding because a five to seven-pound weight gain may be normal for many during the holiday season, the first year of college or  on vacation'

Researchers at the Mayo Clinic in the U.S. found a five to 11 pound weight gain did not affect cholesterol, insulin or blood sugar levels. Dr Naima Covassin, said: ‘This is an important finding because a five to seven-pound weight gain may be normal for many during the holiday season, the first year of college or on vacation’

 

Read more: http://www.dailymail.co.uk/health/article-2750988/Gaining-just-FIVE-pounds-stomach-increases-blood-pressure-study-finds.html#ixzz3D17OFioZ
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Statins could stop diabetics going blind: Pills ‘cut damage to blood vessels in eye’

  • Statins could protect against blindness caused by diabetes, researchers find
  • Patients taking drugs were up to 40% less likely to suffer from complications
  • Added benefit of reducing inflammation in the eye and nerve damage in limbs
  • The Danish researchers looked at 62,716 patients with diabetes aged over 40

By SOPHIE BORLAND FOR THE DAILY MAIL

Statins could protect against blindness and amputations caused by diabetes, researchers have found.

Diabetes patients taking the cholesterol-lowering drugs were up to 40 per cent less likely to develop these complications.

Experts believe the pills may have the added benefit of reducing inflammation in the eye and nerve damage in limbs – which in severe cases can lead to feet being amputated.

Statins could protect against blindness and amputations caused by diabetes, researchers found (file picture)

Statins could protect against blindness and amputations caused by diabetes, researchers found (file picture)

Around 29 per cent of patients with diabetes suffer damage to the blood vessels in the eye, leading to sight problems and one in ten develop foot ulcers.

The complications are debilitating for patients and cost the NHS up to £14billion a year.

Danish researchers looked at 62,716 patients with diabetes aged over 40, during a three-year period. A quarter of them happened to be taking statins for high cholesterol, and the rest had never been prescribed the pills.

The study, published in the Lancet medical journal, showed that patients on statins were 40 per cent less likely to develop sight problems and 34 per cent less at risk of nerve damage.

Lower risk: Diabetes patients taking the cholesterol-lowering drugs were up to 40 per cent less likely to develop these complications (file picture)

Lower risk: Diabetes patients taking the cholesterol-lowering drugs were up to 40 per cent less likely to develop these complications (file picture)

They were 12 per cent less likely to get gangrene in the foot – as a result of an ulcer caused by nerve damage – which often leads to amputation.

The researchers, led by Professor Børge G Nordestgaard, chief physician in clinical biochemistry at Copenhagen University Hospital in Denmark, were surprised by the findings. They had expected statins would make patients more likely to suffer complications, because they further raise blood sugar levels. Other experts think an added benefit of the drugs is that they reduce inflammation in the nerves, preventing them from damage.

In July, health watchdog NICE issued controversial guidelines urging GPs to prescribe statins to 17million patients to prevent heart disease. There is a growing body of research suggesting statins also protect against other illnesses including dementia and certain cancers. But some experts said it was far too early for doctors to consider prescribing statins to all patients with diabetes to prevent complications.

Dr David Preiss, from the British Heart Foundation’s cardiovascular research centre at the University of Glasgow, said: ‘Statins also have anti-inflammatory effects which might slow the progression of microvascular disease (in the small blood vessels) in the eye or kidney.

‘For now, however, any benefit of statins on microvascular complications remains unproven.’

Around 2.9million Britons have diabetes, and 90 per cent of these have Type 2, which is mainly caused by obesity. The numbers have increased by 50 per cent in less than a decade.

The NHS spends £14billion a year treating diabetes, and most of this is on complications.

Simon O’Neill, from the charity Diabetes UK, said: ‘Further research will be needed to find out if statins can actively help to reduce the risk of such complications.

‘The best way for people with Type 1 and Type 2 diabetes to reduce their risk of complications is by taking prescribed diabetes medications and by maintaining a healthy weight through increased physical activity and eating a healthy balanced diet.’

From: http://www.dailymail.co.uk/health/article-2750075/Statins-stop-diabetics-going-blind-Pills-cut-damage-blood-vessels-eye.html

 

Read more: http://www.dailymail.co.uk/health/article-2750075/Statins-stop-diabetics-going-blind-Pills-cut-damage-blood-vessels-eye.html#ixzz3Cv1kUR5F
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