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Arrhythmias 1 Flashcards

(48 cards)

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1
Q

3 mechanisms of arrhythmia

A

Abnormal Automaticity
Triggered Activity
Reentry

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2
Q

3 reasons for abnormal automaticity

A

scar, ischemia, age

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3
Q

examples of abnormal automaticity

A

SSS, afib, PVCs, PACs

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4
Q

? + Torsades = Long QT

A

Bradycardia

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5
Q

Bradycardia + Early after depolarizations = ?

A

Torsades

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6
Q

Bidirectional VT + Dig = ?

A

Delayed after depolarizations

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7
Q

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

A

catecholamines

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8
Q

3 things needed for reentry arrhythmia

A

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

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9
Q

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

A

Increase Sn

Decrease Sp

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10
Q

HV Interval

A

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

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11
Q

Is infrahissian block serious?

A

yes! Can lead to asystole.

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12
Q

Long A-H interval makes you think of?

A

slow/fast AVNRT

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13
Q

Late potentials on Signal Averaged ECG

A

Infarct, scar (slow conduction)

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14
Q

Most common reason to get PPM in US?

A

Sinus node dysfunction

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15
Q

Class I indications for PPM in sinus node Dz

A

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

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16
Q

Class III PPM for SND?

A

1) SND due to nonessential meds

2) asymptomatic

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17
Q

Class I for PPM w/ AVB

A

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

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18
Q

Class III for PPM w/ AVB

A

reversible AVB (lyme, drug tox, OSA)

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19
Q

Class I for PPM w/ bi/trifascicular block

A

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

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20
Q

Class I PPM for AVB post MI

Study These Flashcards
A

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

21
Q

Class III PPM post MI

Study These Flashcards
A

1) new BBB w/o AVB

2) transient AVB w/o BBB

22
Q

Class I for CRT

Study These Flashcards
A
  • EF < 35%
  • QRS > 150ms
  • LBBB (not RBBB!)
  • Class II (NEW!), III, or ambulatory IV CHF
23
Q

what type of syncope is “ominous”

Study These Flashcards
A

syncope w/ exertion

24
Q

what tests are low yield for syncope?

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

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