Cardio Flashcards by Angie Tamin

QT prolongation: Drugs that increase duration of ventricular action potential

Type 1A anti-arrhythmics: quinidine, TCA, procainamide, disopyramide, phenothiazines

Type III: amiodarone and sotalol

Other causes of prolonged QT
-IC bleed (SAH)
-Systemic hypothermia
-Hypocalcemia (ST portion)

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Causes QT shortening

Hypercalcemia
Digital glycosides

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Electrical alternans with sinus tachycardia

Cardiac tamponade

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What tachyarrhythmia has an accelerated phase 4 depolarization ?

Idiopathic VT and AT

If absent / decelerated phase 4 repolarization: sinus node dysfunction

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Infection that can cause AV block typically at the level of the AV node with narrow junctional escape rhythm >40beats/min

Lyme carditis (Borrekia burgdorferi)

improves after 1 week of antibiotic therapy

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Which AV conduction block is Permanent Pacing is required

Mobitz type 2 AV block, high grade AV block, or 3rd degree AV Block that is not reversible or physiologic

OR symptomatic AV block

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Adjunctive pharmacologic treatment useful in AV block.

Atropine 0.5 to 2mg IV OR
isopretwrenol 1-4ug/min IV

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Normal PR interval

120-200ms

QRS: <-= 100ms

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Mechanisms of Pathologic tachycardia

reentrant reentrant arrhythmias dependent on AV nodal conduction
large reentry circuits within atrial tissue (atrial flutter)
focal atrial tachycardia that can be due to automaticity

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Postural orthostatic tachycardia syndrome (POTS)

Sinus rate increased by 30bpm or >120bpm within 10 min of standing without hypotension

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Reversal agent of Dabigatran

Idarucizumab

Factor X- inhibitors (Rivaroxaban, Apixaban Endoxaban): Andexanet alfa

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CHA2DS2VASc and what is the score to start anticoagulation

CHF 1
Hypertension 1
Age >75 2
DM 1
STROKE/TIA, embolus 2
Vascular disease 1
Age 65-75 1
Sex female

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HAS-BLED

HTN: 1
abnormal renal and liver function; 1 each
Bleeding disthesis 1
labile INR ( in warfarin)1
Age >65 1
Drug/ alcohol 1 each

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Cardia imaging that can additionally detect area of ventricular scar

cardiac MRI with Gd contrast

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Class 1 anti arrhythmic drugs and the MOA

Na channel blocker, blocks Na
1C- flecainamide and propefenone
1A- qunidine, procainamide, disopyrimid and TCA
1B- lidocaine, mexilitine

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Class 2 anti arrhythmic drugs and the MOA

Beta blockers
Blocks the phase 4 depolarization by suppressing AV/SA nodal activity

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Class 3 anti arrhythmic drugs and the MOA

K channel blocker: prolonged phase 3 repolarization

Amiodarone
Ibutalide
Doferilide
Sotalol

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Class 4 anti arrhythmic drugs and the MOA

CCB: decreases slope of phase 0,3,4
Prolonged repolarization via AV node.

Non dihydropyridine CCB: Diltiazem and Verapamil

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PVC / NSVT with ACS for ICD indication

> 40days after the AMI: LVEF <30% OR LVEF <35% symptomatic HF (FC II or III)
> 5days after AMI: decrease LVEF + non sustained VT + inducible sustained VT or VF on EP test

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PVCs and NSVT associated with depressed ventricular function and HF, indication for ICD

LVEF <35% NYHA II and III HF (decreased 5-year mortality from 36 to 29%)

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Tachyarrhythmia that always indicates structural abnormality or focus of automaticity

Sustained monomorphic VT

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Arrhythmias with repolarization abnormalities and genetic arrhythmias syndrome

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Acquired long QT: Torsades de pointes
Congenital long QT syndrome: LQTS 1,2,3
short QT syndrome: QTc <0.36s

What is Brugada syndrome

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ST segment elevation > 0.2mV + coved ST segment + negative T wave in more than one anterior precordial lead (V1-V3) + episode of syncope or cardiac arrest due to polymorphic VT in the absence of structural disease

Definition of electrical storm or VT storm

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3 or more VT or VF episodes in 24 hours

Medical treatment of Brugada syndrome with frequent VTs

Quinidine and catheter ablation

High-output heart failure

B eri beri (vitamin B deficiency) A nemia T hyrotoxicosis A rteriovenous shunt M yeloproliferative disorder O besity C hronic lung disease C irrosis

Early radiologic signs of acute HF

-upper zone venous distribution -thickening of interlobular septa

Indication of Cardiac resynchronization therapy in Hf

-NYHA III and IV HFrEF on optimal medical management with mod to severe residual symptoms -minimally symptomatic pt with QRS >149ms + LBBB

SCD in HF: appropriate candidates for ICD

- NYHA II or III with LVEF <35% regardless of etiology - post MI on optimal medical management but with residual LVEF =/< 30% even if asymptomatic -symptomatic HF not caused by CAD <60yo

Which arrhythmia/s have a mechanism of Reentry?

AVNRT, AVRT atrial flutter Scar related VT

Which arrhythmia/s have a mechanism of abnormal automaticity?

Enhanced (acceleration of phase 4 repolarization): Idiopathic VT, AT Suppressed (absent or decelerated phase 4 repolarization): sinus node dysfunction

Which arrhythmia/s have a mechanism of early after depolarization (EADs phase 2/3)?

TdP in long Qt syndrome PVCs

Which arrhythmia/s have a mechanism of delayed afterdepolarization (DADs phase 4)?

Reperfusiob PVCs/VT AT and VT with digitalis toxicity

What are the class 1 indication in AV block permanent pacing ?

Class 1: -Complete heart block (acquired); advanced AV block, mobitz type II evidence of infranodal block -asymptomatic Mobitz type 1 block, with neuromuscular disease associated with progressive conduction tissue disorder

What are the class IIa indication in AV block permanent pacing ?

- symptomatic first degree AV block - first degree AV block, asymptomatic with Lamin A/C cardiomyopathy -symptomatic Mobitz type I block

Class I indication for catheter ablation in Symptomatic AF

-parox or persistent AF with failed drug therapy -parox or persistent AF and heart failure with reduced EF

Most common genetic cardiovascular disorder and prominent caused if SCR. Before 35

HOCM sudden death can be due to polymorphic VT/VF

Most common genetic cardiovascular disorder and prominent caused if SCR. Before 35

HOCM sudden death can be due to polymorphic VT/VF

Hemodynamic hallmark of MS

Abnormally elevated left Atrioventricular pressure gradient

Hallmark of disease progression in MS

Inset of atrial fibrillation

A soft low pitched rumbling mid to late diastolic murmur seen severe AR

Austin flint murmur “Austin Rint murmur” AR-AR

A high pitched diastolic decrescending blowing murmur along the left sternal border results from dilation of the pulmonary valve ring and occurs in mitral valve disease and severe pulmonary hypertension

Graham steell murmur Seen MVD and PR

Mitral commissurotomy indication

symptomatic NYHA II - IV, isolated severe MS orifice =\< 1 cm2/m2 BSA or < 1.5 cm2 in normal sized adults

Hyperplastic disorder affecting medium size and small arteries, predominantly among females

Fibromuscular dysplasia

Arteries commonly affected in Fibromuscular dysplase

More common: Renal and carotid arteries Less common: iliac, subclavian (most common limb artery affected = iliac arteries)

Angiographic finding of Fibromuscular dysplasia

String of beads Tx: PTA, surgical reconstruction

Inflammatory occlusive vascular disorder of small and medium sized arteries and veins in the distal upper and lower extremities

Thromboangitis Obliterans (Buerger’s disease)

Pulseless disease that may involve descending thoracic and abdominal aorta and what is the treatment?

Takayasu’s arteritis Tx: Acute stage: glucocorticoids and immunosuppressives Critical stenotic artery: surgical bypass or endovascular intervention

Pathology of thromboangiitis obliterans on disease progression

Initial stage: PMN migration infiltrating walls of the small and medium-sized arteries and veins Disease progression: PMNs replaced by mononuclear cells, fibroblasts and giant cells Later stages: Perivascular fibrosis and recanalization

Triad of Thromboangiitis obliterans:

Claudication of affected extremity, Raynauds phenomenon, migratory superfical vein, thrombophlebitis

In Acute limb ischemia, what isbthe most frequent site of thrombosis in situ:

Atherosclerotic vessel at site of an atherosclerotic plaque/aneurysm, arterial bypass grafts

When to do Amputation in Acute limb ischemia?

Done if the limb is not viable, loss of sensation, paralysis and the absence of doppler detected blood flow in both arteries and veins

Screening test for Primary Aldosreronism

PA/PRA RATIO >30:1 + plasma aldosterone concentration > 555pmol/L (>20ng/dL): 90% Some antihypertensive medications can affect ratio (must stop drugs 4-6 weeks before test)

Cardio Flashcards

(53 cards)