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Arrhythmias Flashcards

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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
CV stroke rate
Corresponds to number until 5-> 7% 6->10% 7->10% 8->7% 9->15%
22
Afib w/u
r/o hyperthyroidism, pericarditis, pulmonary embolism, and electrolyte abnormalities, echo
23
flecainide class, mechanism
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.
24
mexilitine class, mechanism
1b, increase the rate of membrane depolarization, increase delayed afterdepolarizations, and shorten the refractory period
25
sotalol class, mechanism
III, blocks potassium channels, resulting in prolongation of repolarization, action potential duration, and the refractory period. Reverse use dependence. Also dofetilide.
26
QT prolongation drugs lytes
hydroxychloroquine, fluroquinolones, albuterol hypomag, hypokalemia
27
unexplained syncope
get echo. do not get eeg/carotid u/s
28
When SCN5A variant is identified in primary Brugada patient
asymptomatic first and second degree family members should get genetic screening
29
symptomatic RVOT VT
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
ICD for every EF <30%
regardless of functional status CRT if NYHA class II, III, or ambulatory IV HF+ LBBB+ QRSd ≥150 msec
31
Atrial flutter or AT after ablation for AF due to
macroreentry in the atria due to atrial scarring
32
RVOT VT mechanism CPVT mechanism
Triggered activity encompasses both delayed and early afterdepolarization. Delayed afterdepolarizations
33
Ischemic VT mechanism Fascicular VT mechanism
enhanced normal automaticity and abnormal automaticity Enhanced automaticity within the fasicular system
34
LBBB PVC+ up in inferior leads LBBB + inferior axis+ early R wave transition (by V3)= LBBB+ inferior axis+ late R wave transition
inferior axis LVOT VT RVOT
35
2:1 block
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
different p wave morphology in sinus vs tachycardia=
atrial tachycardia, atrial activity during period of block after adenosine. Ablate.
37
Tachycardic pacing due to
PMT or tracking SVT
38
treatment of inappropriate sinus tach
ivabradine, blocks iF current (located in SA node)
39
WPW first line therapy for symptomatic patients. asymptomatic WPW. any recurrent symptomatic paroxysmal supraventricular tachycardia
ablation risk stratify first with exercise, procainamide challenge is alternative. ablate
40
ARVC (RVH, epsilon wave) lifestyle changes
avoid competitive sports and endurance training. Physical activity may accelerate structural progression. Can play billiards, bowling, cricket, curling, golf, and riflery.
41
Stable AF+ normal EF+ asymptomatic
rate control is adequate
42
Brugada unmaskers Brugada drug treatment
Febrile illnesses, alcohol or cocaine use, procainamide, flecainide, amio Quinidine for ICD+multiple appropriate shocks or if ICD is not possible
43
Atrial flutter management
Do not try to rate control. Go to rhythm control. If atypical (h/o atrial surgery, concordant ps)-> cardiovert.
44
Persistent afib Longstanding persistent
>7 days >12 months
45
Ventricular arrhythmia management
Evaluate for SHD. If SHD-> ICD If no SHD-> drug therapy or catheter ablation
46
WPW Exercise WPW BB/ valsalva (vagal maneuver)
less apparent because exercise improves AV conduction More apparent because they worsen AV conduction
47
most common mechanism of a regular narrow complex tachycardia
AVNRT, then AVRT, then AT
48
Verap+ dofetilide Amio+ warfarin
Increased toxicity of dofetilide Amio increases AC effect of warfarin
49
ARVC EKG
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
Torsades mechanism
Early afterdepolarizations
51
Afib lifestyle changes
Weight loss of ≥10%, treat OSA, treat htn
52
AVNRT ablation target
posterior slow pathway in Koch's triangle
53
Vasovagal syncope treatment
while standing, positive tilt test. conservatively: avoid triggers, hydration, salt, and compression stockings-> midodrine if no HTN, HF or urinary retention
54
LQTS first line
nadolol ICD only if they fail nadolol even if there's already syncope
55
CRT response Causes of nonresponse
>90% pacing AF with RVR, inappropriate device programming, frequent ectopy, loss of LV lead capture or poor LV lead position.
56
LQTS meds
Avoid all QT prolongers and treat electrolyte abnormalities immediately.
57
Timolol brady
worsened by paroxetine
58
Digoxin+ amio
have to decrease digoxin dose, otherwise can cause bidirectional VT. Give digifab.
59
fascicular VT treatment
verap, cure with ablation
60
sustained VT in normal heart treatment
beta-blockers, CCB, and catheter ablation are considered first-line therapies
61
Mixelitine VT
reentry or scar treatment
62
No ablation for asymptomatic arrhythmias
63
AC arrhythmia CV is irrelevant in
AF and AFL valvular afib, HCM, mechanical valve
64
When is it only warfarin for AC?
Mechanical valve, HCM, moderate to severe MS
65
Symptomatic (syncope) 2:1 block=
pacemaker

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