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HARRISSONS > Rhythm > Flashcards

Rhythm Flashcards

1
Q

Mechanism and impulse initiation of torsades de pointes

A

Triggered automaticity

EADS

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2
Q

Mechanism and impulse initiation of digitalis toxicity and reperfusion Vtach

A

Triggered automaticity

DADs

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3
Q

Mechanism and impulse initiation of sinus bradycardia and sinus tachycardia

A

Mechanism: automaticity

Impulse initiation: suppression or acceleration of phase 4

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4
Q

Mechanism and impulse initiation of ischemic ventricular fibrillation and AV block

A

Excitation
Suppression of phase 0
AP SHORTENING
INEXCITABILITY

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5
Q

Mechanism and impulse initiation of polymorphic VT

A

AP PROLONGATION , AED, DADs

REPOLARIZATION

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6
Q

Mechanism and impulse initiation of AF FIBRILLATION

A

AP SHORTENING

REPOLARIZATION

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7
Q

Mechanism and impulse initiation of ischemic VT/ VF

A

Decreased coupling

Cellular coupling

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8
Q

Mechanism and impulse initiation of monomorphic VT, AF

A

EXcitable gap and function RE-ENTRY

TISSUE STRUCTURE

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9
Q

Renders heart inexcitable by depolarizing the membrane potential

A

Hyperkalemia

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10
Q

Due to presence of increased Calcium load In the cytosol and sarcoplasmic reticulum

A

Delayed after depolarization

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11
Q

Causes of DADs

A

Digitalis glycosides
Catecholamines
Ischemia

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12
Q

Causes of EADS

A

Hypokalemia
Hypomagnesemia
Bradycardia
Drugs( class IA and Class III, phenothiazines, nonsedating antihistamines, some antibiotics)

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13
Q

Most common arrhythmia mechanism

A

RE-ENTRY

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14
Q

What type of Re-Entry arrhythmia has no fixed an atomic obstacle, and no fully excitable gap.
Ex AF VF

A

Leading circle Re-Entry

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15
Q

What type of Re-Entry arrhythmia has fixed anatomic structure with anterograde and retrograde limbs of the circuit
Ex
AV RE-ENTRY, ATRIAL FLUTTER, BUNDLE BRANCH REENTRY VENTRICULAR TACHYCARDIA AND VENTRICULAR TACHYCARDIA IN SCARRED MYOCARDIUM

A

Excitable gap Re-Entry
Or
anatomic reentry

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16
Q

Test used to evaluate patients with syncope when suspecting exaggerated vagal tone or vasodepression as a cause

A

HEAD UP TILT TESTING

HUT

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17
Q

Mechanism of bradyarrhythmia

A

Failure of impulse initiation
Or
Impulse conduction

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18
Q

Most common causes of pathological bradycardia

A

Sinus node dysfunction

AV conduction block

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19
Q

Only reliable therapy of bradyarrhythmia if without reversible causes

A

Permanent pacemaker inertion

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20
Q

The incidence of persistent atrial fibrillation in patientswith SA node dysfunction increases with

A

advanced age, hypertension, diabetesmellitus, left ventricular dilation, valvular heart disease, and ventricular pacing.

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21
Q

Patients with the tachycardia-bradycardia variant of SSS,similar to patients with atrial fibrillation are at risk for thromboembolism, and those at greatest risk who should be treated with anticoagulants are:

A

aged ≥65 years
patients with a prior history of stroke,
valvular heart disease,
left ventricular dysfunction, or atrial enlargement,

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22
Q

The electrocardiographic manifestations of SA node dysfunctioninclude

A

sinus bradycardia, sinus pauses, sinus arrest, sinus exit block,tachycardia (in SSS), and chronotropic incompetence

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23
Q

Sinus bradycardia is ABNORMAL if

A

HR<40bpm in the awake state in the absence of physical conditioning

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24
Q

This is alternatively defined as failure to-reach 85% of predicted maximal heart rate at peak exercise or failure to achieve a heart rate >100 beats/min with exercise or a maximal heartrate with exercise less than two standard deviations below that of an age-matched control population. Exercise testing may be useful in discriminating chronotropic incompetence from resting bradycardia

A

Failure to increase the heart rate with exercise is referred to as chronotropic incompetence.

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25
Q

The normal IHR after administration of 0.2 mg/kg propranolol and 0.04 mg/kg atropine is ____; a low IHR is indicative of SA disease.

A

is 117.2 − (0.53 × age) in beats/min

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26
Q

Drugs that may be used In AV BLOCK

A

Atropine 0.5 to 2 mg IV
OR
ISOPROTERENOL 1-4 ung/min IV

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27
Q

Transient abnormality associated with Mobitz type 1 second degree av block:

A

Inferior wall MI
DRUGS (digitalis, CCB, BB)
Increased vagal tone

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28
Q

Associated with PAROXYSMAL AV BLOCK

A

Mobitz Type 2 sec degree AV block

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29
Q

Typical site of block for Mobitz Type 2 sec degree AV block

A

Infranodal

Distal or infra-his conduction system

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30
Q

The most common arrhythmia identified during extended ECG monitoring

A

Atrial premature complexes

31
Q

The SIGNITURE tachycardia of patients with significant pulmonary disease

A

MAT

Multifocal atrial tachycardia

32
Q

Lupus erythematosus like syndrome is commonly seen in slow acetylators of this anti-arrhythmic Agent

A

PROCAINAMIDE

33
Q

Most common sustained arrhythmia

A

AF

34
Q

Approach if AF if adequate rate control is not achieved:

A

Consider restoring to sinus rhythm by CATHETER ABLATION OF AV JUNCTION + placement of PACEMAKER

35
Q

If AF is unclear of <48hours

A

Anticoagulate before cardio version

36
Q

Underlying condition in AF that necessitates anticoagulantion:

A

Mitral stenosis
Hypertrophic CMP
prior history of stroke
CHADSVAS SCORE OF >/= 2 (May consider 1)

37
Q

Anticoagulant choice for rheumatic MS or mechanical heart valves in AF

A

Warfarin (Vitamin k antagonist)

38
Q

Anticoagulant choice for non-valvular AF

A

Warfarin and direct acting anticoagulants

39
Q

ANTITHROMBIN INHIBITORS

choice for non-valvular AF

A

Dabigatran

40
Q

Factor Xa inhibitors used in non-valvular AF

A

Rivaroxaban
APIXABAN
Endoxaban

41
Q

Avoid dabigatran, rivaroxaban and APIXABAN crea clearance is below

A

<15cc/min

If modest renal impairment just adjust to renal dose

42
Q

True or false:

In AF, IF RECURRENCES ARE INFREQUENT, MAY DO PERIODIC CARDIOVERSION.

A

True

43
Q

Pharmacotherapy to maintain sinus rhythm or reduce episodes of AF if without significant structural heart disease:

A

Class IC Sodium channel blocking agents
Flecainide
Propaferone
Disopyramide

44
Q

Pharmacotherapy to maintain sinus rhythm or reduce episodes of AF if with CAD or structural disease:

A

Class III agents
SOTALOL
DOFETILIDE

45
Q

More effective drug compared to others as Pharmacotherapy to maintain sinus rhythm or reduce episodes of AF if with CAD or structural disease:

A

AMIODARONE CLASS III

46
Q

Slightly SUPERIOR compared to DRUG THERAPY for UNTREATED RECURRENT PAROXYSMAL AF

A

Catheter ablation directed at pulmonic veins foci (less effective fir persistent AF)

47
Q

More effective for PERSISTENT AF than catheter ablation

A

SURGICAL ABLATION

48
Q

Have wide QRS complexes > 0.12secs

Capable of automaticity, triggered automaticity, reentry thru areas of scar or diseased purkinje system

A

Ventricular arrhythmias

49
Q

Single ventricular beat that falls earlier than the next anticipated supraventricular beat

A

PVCs

50
Q

> 3 consecutive beats at >100bpm

A

Vtach

51
Q

Distinguishing time between non sustained Vtach and sustained Vtach

A

30 seconds

52
Q

Waxing and waning QRS complex

A

Torsades de pointes

53
Q

PVCs or VTACH in patients without structural heart disease and not associated with genetic syndrome or sudden death

A

Idiopathic ventricular arrhythmia

54
Q

Anti arrhythmic drug for EIA, IDIOPATHIC ARRHYTHMIA

First choice for most ventricular arrhythmia due to safety

A

Beta blocker

55
Q

Block the delayed rectified potassium channel IKR which:
prolongs action potential duration (QT INTERVAL) and cardiac refractory period
Predisposes to TORSADES DE POINTES

A

SOTALOL , DOFETILIDE

K CHANNEL BLOCKERS

56
Q

Most effective anti arrhythmic for ventricular arrhythmia, better than SOTALOL for reducing ICD shocks

A

AMIODARONE

57
Q

Major adverse effects of AMIODARONE Which

Leads to discontinuation in 1/3 of patients

A 
Hyper or Hypothyroidism 
Pneumonitis or pulmonary fibrosis (PULMONARY INFLAMMATION)
Photosensitivity
Peripheral neuropathy 
Ocular toxicity 
Hepatoxicity
58
Q

Major adverse effects of AMIODARONE if given by IV administration for >24 hours via a peripheral vein

A

SEVERE PERIPHERAL THROMBOPHLEBITIS

59
Q

Highly effective for terminating VT AND VF, decreases mortality of sudden cardiac death

A

ICD

implantable cardioverter defibrillators

60
Q

Indications for catheter ablation For VT

A
  1. Recurrent (incessant) ventricular arrhythmias associated with poor cardiac function
  2. Idiopathic VTach and PVCs without structural heart disease
61
Q

Anti-arrhythmic surgery used for recurrent VT DUE to prior MI, some cases of VT in non-ischemic heart diseaSe

A

Surgical cryoablation +/- aneurysmectomy

62
Q

Most common origin of idiopathic ventricular arrhythmia

A

RV OUTFLOW TRACT (LBBB configuration)

63
Q

Structural heart origin in LBBB like configuration

A

RV or IV septum origin

Dominant S in v1

64
Q

Structural heart origin in RBBB like configuration

A

LV origin (Dominang R is V1)

65
Q

ECG characteristic of Vtach with inferior wall origin

A

Negative II III AVF

66
Q

Structural heart origin with ECG: positive II II AVF

A

Cranial aspect of the heart origin

67
Q

Indication for ICD for survivors of AMI with PVCs or non sustained Vtach (decreases mortality)

A

> 40 days after acute MI + LVEF <0.30 + symptomatic HF (II or III)

And

> 5days after MI + Dec LVEF + non sustained VT + inducible sustained VT or VF on electrophysiological testing

68
Q

PVCs at a rate < 100 beats/min

A

Idioventricular rhythm

69
Q

ECG CRITERIA

FOR SUSTAINED VENTRICULAR TACHYCARDIA

A
  1. Presence of AV Dissociation
  2. Monophasic R wave or Rs complex in AVR
  3. Concordance from V1 to V6 of monophasic R or S waves
  4. favors SVT: known BBB + same QRS morphology during tachycardia and sinus rhythm
70
Q

≥3 Vtach or vfib episodes within 24hours

A

Electrical storm or VT storm

71
Q

Management of Electrical storm or VT storm with

prolonged QT causing TDP torsades de pointes

A

IV MAGNESIUM SULFATE

72
Q

Management of Electrical storm or VT storm with

Brugada syndrome

A

QUINIDINE

ISOPROTERENOL

73
Q

The major source of thromboembolism and stroke in AF is formation of thrombus in the _____ where flow is relatively stagnant,although thrombus occasionally forms in other locations as well.

A

left atrial appendage

HARRISSONS (62 decks)

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