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Sinus node dysfunction: Recognition and treatment

doi: 10.1097/01.NPR.0000423812.63114.82
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INSTRUCTIONS Sinus node dysfunction: Recognition and treatment


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Sinus node dysfunction Recognition and treatment

General Purpose: To provide information about diagnosing and managing SND. Learning Objectives: After reading this article and taking this test, the reader should be able to: 1. Explain the etiology and pathophysiology of SND. 2. Describe diagnosis and treatment options for SND.

  1. SND refers to
    1. malformation of the heart anatomy.
    2. abnormalities that cause heart block.
    3. atrial impulse generation/propagation.
    4. a congenital condition involving the sinus node.
  2. What is the mean age in years for diagnosis of SND?
    1. 48
    2. 58
    3. 68
    4. 78
  3. Most cases of SND are
    1. congenital.
    2. idiopathic.
    3. unifactorial.
    4. genetic.
  4. Which of the following is an intrinsic factor in SND development?
    1. cardiomyopathy
    2. carotid sinus hypersensitivity
    3. hypothyroidism
    4. intracranial hypertension
  5. Intrinsic changes are most frequently caused by
    1. cardiac medications.
    2. rheumatic fever.
    3. congenital heart malformations involving the SA node region.
    4. degenerative and/or fibrotic changes in the SA node region.
  6. With increasing age, the SACT
    1. increases.
    2. remains unchanged.
    3. decreases.
    4. becomes erratic.
  7. What medications are most likely to affect sinus node function?
    1. angiotensin-converting enzyme inhibitors
    2. calcium channel blockers
    3. vasopressors
    4. nitrates
  8. Excessive physical training might cause syncope, bradycardia, or AV conduction abnormalities related to
    1. dehydration.
    2. exhaustion.
    3. muscle stimulation.
    4. heightened vagal tone.
  9. The most frequent ECG manifestation in SND is
    1. atrial fibrillation.
    2. heart block.
    3. persistent sinus bradycardia.
    4. ST segment elevation.
  10. Failure of the sinus rate to increase adequately in response to physical stress is called
    1. bradycardia.
    2. sinus arrest.
    3. chronotropic incompetence.
    4. AV conduction deficiency.
  11. A diagnosis of SND requires correlation of symptoms with
    1. tachydysrhythmias.
    2. bradydysrhythmias.
    3. atrial fibrillation.
    4. physical activities.
  12. Long-term monitoring is necessary
    1. for patients who have difficulty activating the monitor.
    2. to capture the onset of symptoms.
    3. for symptoms that are infrequent or transient.
    4. for older adult patients.
  13. In chronotropic incompetence, the sinus node cannot achieve what percent of the age-predicted HR?
    1. 70%
    2. 75%
    3. 80%
    4. 85%
  14. How is maximum-predicted HR calculated?
    1. 120 plus age
    2. 220 plus age
    3. 200 minus age
    4. 220 minus age
  15. The focus of treatment of SND is
    1. alleviating symptoms.
    2. repairing the SA node.
    3. preventing heart block.
    4. decreasing cardiac output.
  16. The only effective treatment for symptomatic bradycardia is
    1. temporary cardiac pacing.
    2. permanent cardiac pacing.
    3. the right combination of medications.
    4. heart-strengthening exercise.
  17. Which is not an advantage of dual-chamber pacing?
    1. prevents syncope during AV block
    2. maintains AV synchrony
    3. reduces risk of atrial fibrillation
    4. high percentage of right ventricular pacing
  18. Which of the following contributes to morbidity and mortality in patients with SND?
    1. thromboembolic complications associated with atrial fibrillation
    2. prolonged bradycardia associated with increased exercise
    3. adverse reactions of cardiac medications
    4. increasingly frequent episodes of heart block


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