Arrhythmias IV

Question 1

WCT + AV dissociation = ?

Answer 1

VT

Question 2

WCT + concordance= ?

Answer 2

VT

Question 3

what does dig tox VT look like on EKG?

Answer 3

narrow complex

Question 4

what does SVT due to drugs look like on EKG?

Answer 4

WCT

Question 5

RBBB> ? = VT

Answer 5

140ms

Question 6

LBBB>? = VT

Answer 6

160ms

Question 7

WCT with R - in I and F = ?

Answer 7

VT

Question 8

what does the presence of negative concordance in WCT rule out?

Answer 8

antidromic tachycardia

Question 9

WCT w/ broad, slurred, notched QRS= ?

Answer 9

VT

Question 10

WCT w/ atypical RBBB/LBBB = ?

Answer 10

VT

Question 11

R/S ratio < 1 in V6 w/ WCT = ?

Answer 11

VT

Question 12

QS in V6 w/ WCT = ?

Answer 12

VT

Question 13

criteria for LBBB

Answer 13

1. QRS > 120ms
2. broad monomorphic R in I, V6 w/o Q waves
3. broad monomorphic S in V1, may have small R

Question 14

criteria for RBBB

Answer 14

1. QRS>120 ms
2. Slurred S in I, V6
3. RSR’ in V1 w/ R’>R

Question 15

Brugada Algorithm

Answer 15

1. No RS in precordial leads
2. R-S>100ms in one precordial lead
3. AV dissociation
4. VT Morphology in V1-V2

Question 16

Sn and Sp of AV dissociation for VT

Answer 16

Sn 82%

Sp 98%

Question 17

Sn and Sp for No RS in precordial leads for VT (Brugada)

Answer 17

Sn 21%

Sp 100%

Question 18

Sn and Sp for R-S>100ms for VT (Brugada)

Answer 18

Sn 21%

Sp 100%

Question 19

Sn and Sp for VT if morphology criteria are met in Brugada algorithm

Answer 19

Sn 99%

Sp 97%

Question 20

aVR criteria for VT

Answer 20

• presence of R wave
• r or q > 40ms
• if QRS -, should be a notch on descending limb

Question 21

what will the HV interval be on an EPS for SVT w/ aberrancy?

Answer 21

normal

Question 22

lidocaine dosing for VT

Answer 22

1mg/kg bolus + .5mg/kg gtt after 5 mins

Question 23

procainamide dosing for VT

Answer 23

20-50 mg/min bolus

watch for hypotension

Question 24

can you use adenosine for acute Rx of VT?

Answer 24

yes

Question 25

can you use BB, CCB or Dig in acute Rx of VT?

Answer 25

No

Question 26

name a good drug for VT,SVT, or preexcitation

Answer 26

procainamide

Question 27

antiarrhythmic Rx for out of hospital arrest (VT)

Answer 27

amio

Question 28

antiarrhythmic for ischemic VT

Answer 28

lidocaine

Question 29

4 drugs you can use for acute VT Rx

Answer 29

lidocaine amio adenosine procainamide

Question 30

does cardiac sarcoid predispose to SCD?

Answer 30

yes

Question 31

does infiltrative CM predispose to SCD?

Answer 31

yes

Question 32

most common cause of SCA in young people?

Answer 32

HCM

Question 33

what can MVP syndrome cause?

Answer 33

SCD

Question 34

Catecholaminergic VT

Answer 34

defect in calcium handling (RYR2/CASQ2 genes) | - exercise induced polymorphic VT

Question 35

LQT1

Answer 35

swimming Rx BB ICD if SCA/syncope

Question 36

LQT2

Answer 36

Sound (alarm clocks) | Rx: BB

Question 37

LQT3

Answer 37

sleep

Question 38

channels involved in LQT1,2,3.

Answer 38

LQT1: Ks LQT2: Kr LQT3: Na (gain of fxn)

Question 39

classic EKG finding in Brugada syndrome

Answer 39

IRBBB w/ ST Elevation

Question 40

most common mech of arrhythia causing SCD in structural heart disease?

Answer 40

reentry

Question 41

if exertional syncope, think of?

Answer 41

Cathecholaminergic VT | Rx: BB, verapamil or ICD

Question 42

AVID trial

Answer 42

Amio vs ICD in Secondary Prevention of SCD >30%mortality reduction at 3 yrs w/ EF< 35% benefited most

Question 43

what is the only good risk stratifier for SCD in CAD pt's?

Answer 43

Decreased LVEF

Question 44

which trial was stopped early and showed benefit of ICD over OMT in pts w/ prior MI and EF<30% ?

Answer 44

MADIT II

Question 45

Trial that showed pt's w/ ICM or NICM and Class II or III HF had decreased mortality with ICD but not w/ Amio in Primary Prevention of SCD.

Answer 45

SCD-HeFT

Question 46

Trial that showed Amio = Placebo in SCD Primary Prevention

Answer 46

SCD-HeFT

Question 47

which two trials are the US guidelines for ICD usein primary prevention? what do they use for risk stratification?

Answer 47

MADIT II SCD-HEFT LVEF

Question 48

Which trial is the basis for ICD use in secondary prevention?

Answer 48

AVID

Question 49

How manu joules of stored energy does an ICD keep?

Answer 49

34J

Question 50

*what is the most common cause for ICD giving inappropriate shocks?

Answer 50

atrial arrhythmias (like afib)

Question 51

how long after an I with EF<35% can you put in ICD?

Answer 51

40d

Question 52

which trial made ICD Class I indication for prior MI/EF< 40%/NSVT/inducible VT?

Answer 52

MUSTT

Question 53

Does CRT-D decrease both morbidity and mortality?

Answer 53

yes(COMPANION)

Question 54

can VT be irregular in the beginning of an EKG?

Answer 54

yes

Question 55

what does a superior "northwest" axis of -90 to +/- 180 (towards aVR) strongly suggest?

Answer 55

VT

Question 56

acute Rx of unstable VT

Answer 56

DC SYNCHRONIZED shock

Question 57

Brugada syndrome mech

Answer 57

loss of fxn of SCN5A

Question 58

Clinical presentation of Brugada

Answer 58

syncope after fever or illmess

Question 59

most common arrhythmia seen with Brugada syndrome

Answer 59

VF

Question 60

can you put an ICD into a pt with prior MI (>40d), LVEF <40%, NSVT and inducible VT?

Answer 60

yes, Class I, MUSST

Question 61

name two arrhythmias causing VF/VT that are amenable to surgery or ablation and are Class III for ICD placement

Answer 61

WPW + RVOT/LVOT VT