EP

Question 1

congenital 2:1 block

Answer 1

LQT syndrome

Question 2

what is the u wave from

Answer 2

repol of purkinje fibers

Question 3

mortality if 2:1 block as a fetus

Answer 3

50% at 6 months, 2/3 by 2 years

Question 4

gene of LQT1

Answer 4

KNCQ1 (Potasium K channel)

Question 5

gene LQT2

Answer 5

KNCQ2 (potassium K channel)

Question 6

gene LQT3

Answer 6

SCN5A (Na channel) Sodium ChaNel

Question 7

elecrolytes that prolong QT

Answer 7

hypoKalemia, hypo Mg, hypo Ca

Question 8

T waves for LQT1,2,3

Answer 8

1 broad, 2 broad with notch, 3 long isoelectric (shark fin)

Question 9

Inverted T waves in V1-V3 at > 14 years old

Answer 9

ARVC (right heart)

Question 10

EKG for ARVC

Answer 10

inverted T wave V1-V3 if > 14 years (right heart)

Question 11

Upright T wave in V1 or V3R between 3 days and 8 years

Answer 11

high spec for RVH

Question 12

qR pattern in right sided precordial leads (V1, V3R, V4R)

Answer 12

severe RVH

Question 13

pure R wave/RR’ in right sided precordial leads (V1, V3R, V4R)

Answer 13

=> RV pressure overload

Question 14

Q waves > 3 mm and tall symmetric T waves in V5 or V6

Answer 14

LV volume overload (PDA) or septal hypertrophy

Question 15

Which leads in ALCAPA

Answer 15

q wwaves Lateral leads, also watch for ST changes and abnormal R wave progression

Question 16

first line fetal SVT if no hydrops, dose target?

Answer 16

digoxin, maternL > 2 (0.6 transfer rate, hydrops decreased by 50%)

Question 17

fetal SVT drugs if hydroptic

Answer 17

sotalol or felcainide

Question 18

risk of sudden cardiac death in LQTS

Answer 18

1) QTc>500 2) previous episode of syncope

Question 19

infantile atrial flutter, Tx and Px?

Answer 19

Tx: DC cardioversion Px: good, low risk recurrence

Question 20

strongest predictors of risk of SCD in HCM

Answer 20

1)fam Hx sudden death 2) septal thickness >30mm

secondary predictors: NSVT, syncope, BP blunting with exercise

Question 21

amiodarone drug drug interactions?

Answer 21

inc warfarin effect, digoxin + phenytoin levels, class I antiarrythmic toxicity

Question 22

borrelia burgdorferi

Answer 22

lyme disease, central clearing = erythma migrans: treat with doxy or ceftiaxone

Question 23

sports EKG with T wave inversions, which are normal abnormal, what do you do?

Answer 23

normal V1, abnormal V5,V6, get an echo

Question 24

opthalmoplegia + heart block, what is it?

Answer 24

Kearns-Sayre syndrome. (mitochondrial defect with ataxia, eye muscle stuff, vision problems, heart block), implant a pacemaker if bifascicular block. [Corn Slayer - corn is for eyebals, slayer is for slicing the conduction system]

Question 25

bad prognosis LQTS in a newborn

Answer 25

LQTS with 2:1 block -> 50% mortality

Question 26

what does lack of HR variability in a fetal indicate?

Answer 26

fetal hypoxemia -> CNS depression -> loss of fetal HR variability

Question 27

why is the T wave in V1 positive at birth?

Answer 27

early repol of the LV and late termination of depolarization from the RV

Question 28

wat causes PJRT?

Answer 28

slow accesory pathwya in the right posterior septum | slow -> P wave visable (negative in II, III, aVF, due to location), slower rate (150-200)

Question 29

what CHD is associated with CHB?

Answer 29

ccTGA, LAI, DORV, AVSD: poor prognosis 30% 1 yr survival

Question 30

1st child had autoimmune fetal CHB, what is risk for child 2?

Answer 30

11-19%

Question 31

risk of CHB if SSA> 50?

Answer 31

1-5% (second child 11-19%)

Question 32

medication contraindicated in WPW?

Answer 32

verapamil

Question 33

intracardiac tracing where most activity falls under the QRS?

Answer 33

typical AVNRT

Question 34

tachycardia that is wide and irregular

Answer 34

a fib with WPW

Question 35

when is adenosine contraindicated?

Answer 35

wide irregular tachycardia = a fib with WPW

Question 36

how does pacemaker mediated tachycardia work?

Answer 36

V pace, retrograde through AV node, atrial activation, "p" wave sensed and V is paced

Question 37

intracardiac, stim of atrium: what do you check?

Answer 37

conduction to V, then check HV interval if negative WPW

Question 38

intracardiac, stim of ventricle: what do you check?

Answer 38

conduction to A, midline or eccentric

Question 39

intracardiac, no stim, next question

Answer 39

fast or slow

Question 40

intracardiac, no stim, slow, what to look for

Answer 40

earliest A

Question 41

intracardiac, no stim, fast, 3 questions

Answer 41

narrow/wide, reg/irregular, A/V relationship

Question 42

intracardiac, no stim, fast, more As than Vs

Answer 42

A fib or A flutter

Question 43

intracardiac, no stim, fast, more Vs than As

Answer 43

junctional or VT: junctional shows a his deflection before the QRS, VT may have dissociated As and Vs

Question 44

intracardiac, no stim, fast, #As = #Vs, what to look for?

Answer 44

look for earliest A