Arrhythmias 1 Flashcards Preview

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Flashcards in Arrhythmias 1 Deck (48):
1

3 mechanisms of arrhythmia

Abnormal Automaticity
Triggered Activity
Reentry

2

3 reasons for abnormal automaticity

scar, ischemia, age

3

examples of abnormal automaticity

SSS, afib, PVCs, PACs

4

? + Torsades = Long QT

Bradycardia

5

Bradycardia + Early after depolarizations = ?

Torsades

6

Bidirectional VT + Dig = ?

Delayed after depolarizations

7

whereas Long QT is exacerbated by bradycardia, what exacerbate delayed afterdepolarizations?

catecholamines

8

3 things needed for reentry arrhythmia

2 pathways
slow/fast
unidirectional block in 1 of the pathways

9

In terms of Sn/Sp, what do NTG and Isoproterenol do in a tilt table test?

Increase Sn
Decrease Sp

10

HV Interval

normal = 35-55 msec
Autonomic factors little influence
if HV>100ms--> PPM needed (even if asymptomatic)

11

Is infrahissian block serious?

yes! Can lead to asystole.

12

Long A-H interval makes you think of?

slow/fast AVNRT

13

Late potentials on Signal Averaged ECG

Infarct, scar (slow conduction)

14

Most common reason to get PPM in US?

Sinus node dysfunction

15

Class I indications for PPM in sinus node Dz

1) SND w/ symptomatic brady
2) SND w/ chronotropic incomp.
3) SND w/ symptomatic brady and required meds

16

Class III PPM for SND?

1) SND due to nonessential meds
2) asymptomatic

17

Class I for PPM w/ AVB

1) sxs brady
2) >3s pauses (>5s if a fib)
3) required meds that cause AVB
4) 2nd degree AVB w/ sxs brady
5) neuromuscular dz (muscular dystrophy, Kearns-Sayre)
6) AVB w/ exercise but no ischemia
7) awake, no sxs , escape rate 40 w/ either LV dysfxn or known to be infranodal block

18

Class III for PPM w/ AVB

reversible AVB (lyme, drug tox, OSA)

19

Class I for PPM w/ bi/trifascicular block

1) intermittent 3rd degree AVB
2) 2nd degree type II AVB
3) alternating BBB

20

Class I PPM for AVB post MI

1) persistent and symptomatic 2nd or 3rd deg AVB
2) persistent infrahissian block (R/LBBB)
3) transient blocks (incld. BBB)

21

Class III PPM post MI

1) new BBB w/o AVB
2) transient AVB w/o BBB

22

Class I for CRT

- EF < 35%
- QRS > 150ms
-LBBB (not RBBB!)
- Class II (NEW!), III, or ambulatory IV CHF

23

what type of syncope is "ominous"

syncope w/ exertion

24

what tests are low yield for syncope?

neuro

25

Which phase of AP is If?

4

26

What is phase 0 (upstroke) of SAN AP due to?

Ca

27

Which AP phase and current does beta adrenergic stimulation affect?

Phase 4
If

28

In what phase do early after depolarizations occur?

3

29

What clinical scenario is associated with early after depolarizations?

Long QT

30

What phase of AP are delayed after depolarizations seen in?

4

31

Name 2 clinical scenarios associated with delayed after depolarizations

Calcium overload
Dig tox

32

What mech of arrhythmia causes DAD's?

Triggered activity

33

If you see a wide complex tachycardia with beat to beat variation of axis, what is most likely diagnosis?

Bidirectional VT from dig toxicity

34

What mech of arrhythmia is scar related VT (monomorphic)

Reentry

35

Who usu gets primary vasodepressor response on tilt table test? Rx? (Not orthistatic b/c takes time)

LOL with BP drop in church
- hydration, salt, MIDODRINE

36

What happens in cardio inhibitory response on tilt table test? Who gets it?

Pro drone of nausea then Asystole then BP drop then syncope
Young

37

What to think of if HV< 35ms?

Pre-excitation

38

What part of conduction system is most common area of irreversible AV block?

His bundle

39

What is rate related BBB called?

Ashman phenomenon

40

How do you program a ppm if there is AVB, you desire AV synchrony but atrial sensing only?

Dual chamber
VDD

41

Why does high impedance (>3000) of a lead occur?

Lead fracture

42

Why does low impedance (< 200) of a lead occur?

Insulation compromise

43

Rx for Pacemaker Mediated Tachycardia

Inc PVARP to blind PPM to retrograde beat

44

Pacemaker syndrome pt's have vague complaints; what is Rx?

Programming changes

45

What class indication is it to put PPM for infra-hissian block or HV > 100ms?

Class II (do it!)

46

Where is the LV lead placed for CRT?

Lateral LV epicardium or CS if endocardial

47

According to new guidelines, what class is PPM for QRS 120-149?

IIa

48

What does beta adrenergic stimulation do to If channel?

Increases the current and makes threshold more negative