ABIM Clinical EP flashcards
ABIM Clinical EP · Build recall with a focused review session.
32 cards. Read the term and the definition here. The deck at the top of this page is optional.
- Bazett QTc formula
- QTc = QT divided by the square root of the RR interval in seconds. Used to correct QT for heart rate; values above 500 ms markedly increase torsades risk.
- Typical AVNRT mechanism
- Reentry using slow AV nodal pathway antegrade and fast pathway retrograde. Produces narrow-complex tachycardia with short RP interval and pseudo-R' in V1.
- WPW pre-excited AF treatment
- Avoid AV nodal blockers such as adenosine, verapamil, digoxin, and diltiazem because they can accelerate ventricular response. Use procainamide or synchronized cardioversion.
- Brugada type 1 pattern
- Coved ST elevation of 2 mm or more in V1-V2 followed by negative T wave. Associated with ventricular fibrillation and sudden death; ICD for high-risk patients.
- Cavotricuspid isthmus ablation
- Curative ablation target for typical atrial flutter. Creates a line between tricuspid annulus and inferior vena cava, eliminating the reentrant circuit.
- Amiodarone toxicity monitoring
- Requires periodic thyroid, liver, and pulmonary function testing plus ophthalmologic exam. Pulmonary toxicity and thyrotoxicosis are major adverse effects.
- Femoral vein anatomy
- Located medial to the femoral artery in the femoral triangle. Puncture site is below the inguinal ligament to avoid retroperitoneal bleeding.
- Subxiphoid pericardiocentesis direction
- Needle inserted below xiphoid and directed toward left shoulder, aspirating while advancing. Continuous ECG monitoring detects myocardial contact via ST changes.
- Transseptal puncture landmark
- Fossa ovalis lies in the mid-to-posterior and inferior septum. Confirm position with pressure, contrast, and echocardiography before dilating.
- Radiofrequency lesion size
- Determined by power, duration, contact force, and irrigation. Irrigated catheters reduce thrombus and permit higher power for deeper lesions.
- Cryoablation AVNRT endpoint
- Freeze to about -30 to -40 C for 2-4 minutes. Monitor for AV block during freezing and stop if block persists to avoid permanent injury.
- Heparin ACT during ablation
- Target activated clotting time of 300-350 seconds during left atrial procedures. Prevents thrombus formation on catheters and sheaths.
- Cardiac tamponade after ablation
- Abrupt hypotension with echo showing effusion and right-sided chamber collapse. Treat with immediate pericardiocentesis and anticoagulation reversal.
- Phrenic nerve injury risk
- Highest during right atrial or superior vena cava ablation. Monitor diaphragm capture with pacing and stop energy delivery on loss of capture.
- Informed consent elements
- Includes indication, alternatives, risks, benefits, and trainee participation. Confirm understanding using teach-back before obtaining signature.
- SPIKES breaking bad news
- Setting, Perception, Invitation, Knowledge, Empathy, Strategy and summary. Structured framework for delivering serious news to patients and families.
- ICD shared decision-making
- Discuss sudden death risk reduction, quality-of-life impact, driving restrictions, and end-of-life deactivation. Elicit patient values before implantation.
- Teach-back method
- Ask patient to restate the plan in their own words. Confirms comprehension better than asking whether they understand.
- Professional interpreter use
- Required for limited English proficiency to ensure accurate communication. Avoid using family members for clinical discussions.
- Closed-loop communication
- Team member verbalizes an order and receiver confirms receipt. Reduces procedural errors in high-stakes electrophysiology laboratory settings.
- Medical error disclosure
- Honest, prompt disclosure to the patient supports trust and is an ethical obligation. Document the event and the discussion.
- Conflict of interest management
- Disclose industry relationships and recuse from decisions where bias could affect patient care. Transparency preserves professional integrity.
- Informed refusal
- Competent patients may decline recommended therapy. Document capacity assessment and the discussion of risks and alternatives.
- Impaired colleague reporting
- Report through appropriate institutional channels. Patient safety takes priority over collegial loyalty.
- Substituted judgment standard
- Surrogate decisions should reflect what the patient would have wanted. Used when patient wishes are known but not formally documented.
- STEMI door-to-balloon target
- Target under 90 minutes at PCI-capable centers; under 120 minutes when transfer is required. Systems pathways reduce delays.
- CIED remote monitoring
- Transmits device data for early detection of lead failure and arrhythmias. Requires established alert triage workflows to be effective.
- CHA2DS2-VASc score
- Estimates stroke risk in atrial fibrillation. Guides anticoagulation decisions along with bleeding risk assessment.
- HAS-BLED score
- Estimates bleeding risk on anticoagulation. High scores prompt closer monitoring and correction of modifiable risk factors rather than withholding therapy.
- Device advisory management
- Systems for patient notification and registry tracking enable rapid identification of affected patients. Coordinate replacement decisions with shared decision-making.
- PDSA cycle
- Plan-Do-Study-Act tests small changes iteratively before broad implementation. Core method for quality improvement projects.
- Morbidity and mortality conference
- Structured case review identifying systems failures and cognitive errors. Aims at learning rather than individual blame.