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ACCSAP > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Sotalol QT prolongation (torsades)

A

Class III, blocks inward potassium channel
reverse use dependence: QT lengthens as HR slows
Also dofetilide.

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2
Q

stable torsades
unstable torsades

A

IV mag-> IV isoproterenol-> pacing
defib

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3
Q

Causes of polymorphic VT

A

preceded by a pause or transient slowing of the heart rate with prolonged QT= prolonged QT

myocardial ischemia

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4
Q

sinus pauses, tachy brady in afib due to

A

sinus node disease

flecainide (class 1C)-> blocks sodium channels-> bradycardia

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5
Q

Azithromycin

A

Prolongs QT-> Triggers early afterdepolarizations-> PMVT
Class 1a, III drugs also do this.

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6
Q

Acute ischemia VT mechanism

A

re-entry due to loss of the epicardial action-potential dome in phase II

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7
Q

Typical atrial flutter
Atypical
Atrial arrhythmias origin

A

positive in V1, from CTI
fossa ovalis or superior vena cava
crista terminalis

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8
Q

Brugada ECG

Brugada ICD

A

use high precordial leads in the second intercostal space or after administration of sodium channel blocking drugs (flecainide or ajmaline). Do in type 2 or type 3.
Type 1+ syncope+ fam SCD. If asymptomatic, no ICD.

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9
Q

ARVC arrhythmia diagnosis

A

isoproterenol challenge

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10
Q

Marked first degree AV block can cause near syncope and confusion through

A

AV dyssynchrony (atrial contraction before complete atrial filling-> ventricular filling is compromised)= cannon A waves, >300 ms

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11
Q

Cardio inhibitory syncope

A

vagally mediated

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12
Q

WPW afib treatment, stable
unstable

A

Ibutilide or IV procainamide
cardioversion

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13
Q

Acute onset AF, >48 hours AC:
CV 0

CV 1

A

4 weeks after cardioversion, then nothing

AC forever

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14
Q

Monomorphic VT in CAD mechanism
Electrolyte abnormalities VT mechanism

A

Reentry
Enhanced automaticity

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15
Q

probability of positive genetic screen for LQTS.
QT>480 + recurrent syncope

A

QT >480 ms

LQTS. No need for genetics

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16
Q

Unstable VT

A

Cardiovert

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17
Q

Palpitations with exercise and emotional stress+ fam SCD

A

CPVT (ryanodine receptor or calsequestrin receptor

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18
Q

AF with RVR in patient with CRT

A

Can decrease pacing percentage and efficacy -> AV nodal ablation

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18
Q

(TGF-β) mutations

fibrillin
plakophilin

A

familial thoracic aortic aneurysm diseases
Marfan
ARVC

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18
Q

Antiarrhythmics in AF

A

Do not use in permanent AF

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18
Q

Periprocedure AC

A

Don’t stop AC in moderate-to-severe mitral stenosis, a mechanical heart valve, or hypertrophic cardiomyopathy. If CV is super high, also continue.

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19
Q

Chronotropic incompetence due to sinus node dysfunction

Deconditioning

A

Must reach 80% maximum predicted HR

Exaggerated HR response

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20
Q

Normal HV interval

A

35-55 ms. If prolonged-> PPM

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21
Q

Univentricular pacing > 40%

A

upgrade to CRT

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22
Q

CV stroke rate

A

Corresponds to number until
5-> 7%
6->10%
7->10%
8->7%
9->15%

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22
Q

Afib w/u

A

r/o hyperthyroidism, pericarditis, pulmonary embolism, and electrolyte abnormalities, echo

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23
Q

flecainide class, mechanism

A

1c, slow conduction by blocking open sodium channels, effective at rapid heart rates= use dependent.
Propafenone also. Can unmask sinus node dysfunction, prolong PR, prolong QRS. Get 30 day monitor.

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24
Q

mexilitine class, mechanism

A

1b, increase the rate of membrane depolarization, increase delayed afterdepolarizations, and shorten the refractory period

25
Q

sotalol class, mechanism

A

III, blocks potassium channels, resulting in prolongation of repolarization, action potential duration, and the refractory period. Reverse use dependence. Also dofetilide.

26
Q

QT prolongation drugs
lytes

A

hydroxychloroquine, fluroquinolones, albuterol
hypomag, hypokalemia

27
Q

unexplained syncope

A

get echo. do not get eeg/carotid u/s

28
Q

When SCN5A variant is identified in primary Brugada patient

A

asymptomatic first and second degree family members should get genetic screening

29
Q

symptomatic RVOT VT

A

may be seen in normal hearts.
left bundle branch block with inferior axis and late R-wave progression beyond V3.
In normal hearts=Ablate. If ARVC: beta blockers-> ablate.

30
Q

ICD for every EF <30%

A

regardless of functional status
CRT if NYHA class II, III, or ambulatory IV HF+ LBBB+ QRSd ≥150 msec

31
Q

Atrial flutter or AT after ablation for AF due to

A

macroreentry in the atria due to atrial scarring

32
Q

RVOT VT mechanism

CPVT mechanism

A

Triggered activity encompasses both delayed and early afterdepolarization.
Delayed afterdepolarizations

33
Q

Ischemic VT mechanism
Fascicular VT mechanism

A

enhanced normal automaticity and abnormal automaticity
Enhanced automaticity within the fasicular system

34
Q

LBBB PVC+ up in inferior leads
LBBB + inferior axis+ early R wave transition (by V3)=
LBBB+ inferior axis+ late R wave transition

A

inferior axis
LVOT VT
RVOT

35
Q

2:1 block

A

exercise (improves AV conduction and worsens His conduction) to differentiate b/w Mobitz 1 (AV nodal) and 2 (His).
Carotid massage does the opposite.

36
Q

different p wave morphology in sinus vs tachycardia=

A

atrial tachycardia, atrial activity during period of block after adenosine. Ablate.

37
Q

Tachycardic pacing due to

A

PMT or tracking SVT

38
Q

treatment of inappropriate sinus tach

A

ivabradine, blocks iF current (located in SA node)

39
Q

WPW first line therapy for symptomatic patients.
asymptomatic WPW.

any recurrent symptomatic paroxysmal supraventricular tachycardia

A

ablation

risk stratify first with exercise, procainamide challenge is alternative.
ablate

40
Q

ARVC (RVH, epsilon wave) lifestyle changes

A

avoid competitive sports and endurance training. Physical activity may accelerate structural progression.
Can play billiards, bowling, cricket, curling, golf, and riflery.

41
Q

Stable AF+ normal EF+ asymptomatic

A

rate control is adequate

42
Q

Brugada unmaskers

Brugada drug treatment

A

Febrile illnesses, alcohol or cocaine use, procainamide, flecainide, amio
Quinidine for ICD+multiple appropriate shocks or if ICD is not possible

43
Q

Atrial flutter management

A

Do not try to rate control. Go to rhythm control. If atypical (h/o atrial surgery, concordant ps)-> cardiovert.

44
Q

Persistent afib
Longstanding persistent

A

> 7 days
12 months

45
Q

Ventricular arrhythmia management

A

Evaluate for SHD.
If SHD-> ICD
If no SHD-> drug therapy or catheter ablation

46
Q

WPW Exercise
WPW BB/ valsalva (vagal maneuver)

A

less apparent because exercise improves AV conduction
More apparent because they worsen AV conduction

47
Q

most common mechanism of a regular narrow complex tachycardia

A

AVNRT, then AVRT, then AT

48
Q

Verap+ dofetilide
Amio+ warfarin

A

Increased toxicity of dofetilide
Amio increases AC effect of warfarin

49
Q

ARVC EKG

A

anterior TWIs, epsilon wave, RVH, RBBB. Even if echo is normal, get MRI if there’s h/o VT.
ARVC VT: beta blockers-> ablation

50
Q

Torsades mechanism

A

Early afterdepolarizations

51
Q

Afib lifestyle changes

A

Weight loss of ≥10%, treat OSA, treat htn

52
Q

AVNRT ablation target

A

posterior slow pathway in Koch’s triangle

53
Q

Vasovagal syncope

treatment

A

while standing, positive tilt test.
conservatively: avoid triggers, hydration, salt, and compression stockings-> midodrine if no HTN, HF or urinary retention

54
Q

LQTS first line

A

nadolol
ICD only if they fail nadolol even if there’s already syncope

55
Q

CRT response
Causes of nonresponse

A

> 90% pacing
AF with RVR, inappropriate device programming, frequent ectopy, loss of LV lead capture or poor LV lead position.

56
Q

LQTS meds

A

Avoid all QT prolongers and treat electrolyte abnormalities immediately.

57
Q

Timolol brady

A

worsened by paroxetine

58
Q

Digoxin+ amio

A

have to decrease digoxin dose, otherwise can cause bidirectional VT. Give digifab.

59
Q

fascicular VT treatment

A

verap, cure with ablation

60
Q

sustained VT in normal heart treatment

A

beta-blockers, CCB, and catheter ablation are considered first-line therapies

61
Q

Mixelitine VT

A

reentry or scar treatment

62
Q

No ablation for asymptomatic arrhythmias

A
63
Q

AC arrhythmia
CV is irrelevant in

A

AF and AFL
valvular afib, HCM, mechanical valve

64
Q

When is it only warfarin for AC?

A

Mechanical valve, HCM, moderate to severe MS

65
Q

Symptomatic (syncope) 2:1 block=

A

pacemaker

ACCSAP (10 decks)

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