Arrhythmias III

Question 1

how long after TEE DCCV do you A/C?

Answer 1

4 weeks

Question 2

which SVT is due to automaticity?

Answer 2

AT

Question 3

Rx for MAT?

Answer 3

treat underlying dz

CCBs

Question 4

which SVT has a pseudo RSR’ and retrograde p?

Answer 4

AVNRT

Question 5

if you see an EPS w/ everything lined up in a row, what does this mean?

Answer 5

simultaneous A & V activation

Pathognomonic for AVNRT

Question 6

Rx for recurrent symptomatic AVNRT

Answer 6

ablation
Verapamil, dilt
BB

Question 7

Rx for recurrent AVNRT refracgtory to BB, CCB and pt does not want ablation?

Answer 7

flecainide, propafenone, sotalol

Question 8

what happens to AVNRT w/ adenosine?

Answer 8

abrupt termination

Question 9

is “no therapy” a Class I indication for AVNRT that is well tolerated?

Answer 9

yes

also can treat with meds or ablation

Question 10

pre-excitation + ? = WPW

Answer 10

sxs

Question 11

*what is a Class I Rx for Pre-excitation?

Answer 11

Nothing. (this is not WPW unless sxs)

Question 12

*What is a class I Rx for WPW?

Answer 12

catheter ablation

Question 13

*name 3 meds not to give in WPW

Answer 13

verapamil/dilt/dig

Question 14

*can you give BB in WPW?

Answer 14

yes (class IIa), unless in afib!

Question 15

*can you do ablation on Pre-excitation?

Answer 15

yes (class IIa), but doing nothing is Class I.

Question 16

*if pt. refuses ablation for WPW, what meds can you give?

Answer 16

flecainide/propafenone
sotalol/amio
BB

Question 17

what meds are contraindicated in WPW/pre-excitation with a fib?

Answer 17

BB

CCB

Question 18

meds that can cause AT

Answer 18

Dig (AT w/ 2:1 AVB)
Albuterol
catecholamines/caffeine

Question 19

mechanisms of AT

Answer 19

automatic
triggered
reentrant

Question 20

MAT

Answer 20

> 3 p waves

- look for chronic dz

Question 21

AT response to adenosine

Answer 21

variable

can be diagnostic

Question 22

Rx for hemodynamically unstable AT

Answer 22

DCCV

Question 23

acute Rx for AT rate control (Class I)

Answer 23

BB, vera/dilt

Question 24

Class I Rx for RECURRENT AT

Answer 24

ablation
BB
CCB

Question 25

do you treat non sustained & asymptomatic AT?

Answer 25

No

Question 26

ablation success rate in AT

Answer 26

90

Question 27

ablation success rate in AT

Answer 27

90

Question 28

whats the best rate-control Rx for poorly tolerated Afl?

Answer 28

BB>CCB

Question 29

whats the best conversion med for stable Afl?

Answer 29

ibutilide

Question 30

3 EKG findings in AFL

Answer 30

- sawtooth in II, III, F - +p in V1, V2 - -p in V3-V6.

Question 31

effects of BB on fetus

Answer 31

FGR reduce placental weight brady/hypoglycemia preterm labor & reduced baby weight

Question 32

effects of BB on fetus

Answer 32

FGR reduce placental weight brady/hypoglycemia preterm labor & reduced baby weight

Question 33

can you use CCBs in pregnancy?

Answer 33

No

Question 34

Amio effects on fetus

Answer 34

congenital goiter hypo/hyperthyroid Long QT

Question 35

Amio effects on fetus

Answer 35

congenital goiter hypo/hyperthyroid Long QT

Question 36

can you perform DCCV on pregnant pt's?

Answer 36

yes

Question 37

quinidine side effects on fetus

Answer 37

oxytocic properties/preterm labor

Question 38

Class I recs to acutely convert pregnant pt. in SVT

Answer 38

Vagal maneuvers DCCV Adenosine

Question 39

*Class III recs for SVT Rx in pregnant pt's

Answer 39

atenolol | amio

Question 40

Class III recs for SVT Rx in pregnant pt's

Answer 40

atenolol | amio

Question 41

what BB can you NEVER use in pregnancy

Answer 41

atenolol

Question 42

what is NOT associated with RVOT VT?

Answer 42

structural heart dz

Question 43

ECG findings for RVOT VT

Answer 43

- LBBB-like | - tall R in II, III, F

Question 44

Rx for 1st episode of RVOT VT

Answer 44

BB | CCB

Question 45

Rx for RVOT VT refractory to meds or unstable or with syncope/pre-syncope

Answer 45

ablation

Question 46

which drug used pre-transplant can cause arrhythmia post-OHT?

Answer 46

Amio

Question 47

Ddx of arrhythmia etiology in OHT

Answer 47

``` rejection Pre-OHT amio suture lines (AFL) surgical trauma to SAN/AVN accelerated atherosclerosis/preservation ischemia ```

Question 48

what is the most common EKG abnormality post-OHT?

Answer 48

Incomplete -RBBB

Question 49

Is VT/VF common post-OHT

Answer 49

No. look for other causes (MI/rejection/CM)

Question 50

are AF/AFL commonly assoc. w/ rejection post-OHT?

Answer 50

yes!

Question 51

what to do if you see AF/AFL post-OHT

Answer 51

Bx-->steroids

Question 52

why don't you give adenosine post-OHT

Answer 52

due to adenosine supersensitivity (5-fold inc in response by SAN/AVN after loss of parasympathetics)

Question 53

what determines the onset/prognosis of tachycardia-induced CM?

Answer 53

rate and duration

Question 54

Rx for Tachycardia CM

Answer 54

rate control CHF OMT ablation

Question 55

can you reverse all types of tachycardia-CM?

Answer 55

no

Question 56

How quickly is Tachycardia-CM reversed?

Answer 56

48hrs, full resolution in 2 weeks | not all TCM are reversible

Question 57

PVC burden of ?% distinguishes CM vs. nl EF? what to do if PVC burden > 10%?

Answer 57

40% | ischemic w/u

Question 58

What type of SVT is WPW?

Answer 58

AVRT

Question 59

Name the type of AVRT (orthodromic or antidromic): | Down AVN, up bypass tract, narrow complex

Answer 59

Orthodromic

Question 60

Name the type of AVRT (orthodromic or antidromic): | Down bypass tract, up AVN, wide complex

Answer 60

Antidromic

Question 61

Which SVT does. It require AVN, His-purkinje, or accessory pathway for its initiation or maintenance?

Answer 61

A tach

Question 62

Mech of RVOT VT

Answer 62

cAMP mediated triggered activity

Question 63

Precipitates for RVOT VT

Answer 63

Exercise Stress Caffeine

Question 64

Why is the initial treatment of RVOT VT counterintuitive?

Answer 64

Because you give BB or CCB, NOT ablation/ICD