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MI HARRISSONS > Rhythm > Flashcards

Rhythm Flashcards

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1
Q

Mechanism and impulse initiation of torsades de pointes

A

Triggered automaticity

EADS

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2
Q

Mechanism and impulse initiation of digitalis toxicity and reperfusion Vtach

A

Triggered automaticity

DADs

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3
Q

Mechanism and impulse initiation of sinus bradycardia and sinus tachycardia

A

Mechanism: automaticity

Impulse initiation: suppression or acceleration of phase 4

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4
Q

Mechanism and impulse initiation of ischemic ventricular fibrillation and AV block

A

Excitation
Suppression of phase 0
AP SHORTENING
INEXCITABILITY

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5
Q

Mechanism and impulse initiation of polymorphic VT

A

AP PROLONGATION , AED, DADs

REPOLARIZATION

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6
Q

Mechanism and impulse initiation of AF FIBRILLATION

A

AP SHORTENING

REPOLARIZATION

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7
Q

Mechanism and impulse initiation of ischemic VT/ VF

A

Decreased coupling

Cellular coupling

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8
Q

Mechanism and impulse initiation of monomorphic VT, AF

A

EXcitable gap and function RE-ENTRY

TISSUE STRUCTURE

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9
Q

Renders heart inexcitable by depolarizing the membrane potential

A

Hyperkalemia

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10
Q

Due to presence of increased Calcium load In the cytosol and sarcoplasmic reticulum

A

Delayed after depolarization

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11
Q

Causes of DADs

A

Digitalis glycosides
Catecholamines
Ischemia

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12
Q

Causes of EADS

A

Hypokalemia
Hypomagnesemia
Bradycardia
Drugs( class IA and Class III, phenothiazines, nonsedating antihistamines, some antibiotics)

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13
Q

Most common arrhythmia mechanism

A

RE-ENTRY

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14
Q

What type of Re-Entry arrhythmia has no fixed an atomic obstacle, and no fully excitable gap.
Ex AF VF

A

Leading circle Re-Entry

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15
Q

What type of Re-Entry arrhythmia has fixed anatomic structure with anterograde and retrograde limbs of the circuit
Ex
AV RE-ENTRY, ATRIAL FLUTTER, BUNDLE BRANCH REENTRY VENTRICULAR TACHYCARDIA AND VENTRICULAR TACHYCARDIA IN SCARRED MYOCARDIUM

A

Excitable gap Re-Entry
Or
anatomic reentry

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16
Q

Test used to evaluate patients with syncope when suspecting exaggerated vagal tone or vasodepression as a cause

A

HEAD UP TILT TESTING

HUT

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17
Q

Mechanism of bradyarrhythmia

A

Failure of impulse initiation
Or
Impulse conduction

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18
Q

Most common causes of pathological bradycardia

A

Sinus node dysfunction

AV conduction block

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19
Q

Only reliable therapy of bradyarrhythmia if without reversible causes

A

Permanent pacemaker inertion

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20
Q

The incidence of persistent atrial fibrillation in patientswith SA node dysfunction increases with

A

advanced age, hypertension, diabetesmellitus, left ventricular dilation, valvular heart disease, and ventricular pacing.

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21
Q

Patients with the tachycardia-bradycardia variant of SSS,similar to patients with atrial fibrillation are at risk for thromboembolism, and those at greatest risk who should be treated with anticoagulants are:

A

aged ≥65 years
patients with a prior history of stroke,
valvular heart disease,
left ventricular dysfunction, or atrial enlargement,

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22
Q

The electrocardiographic manifestations of SA node dysfunctioninclude

A

sinus bradycardia, sinus pauses, sinus arrest, sinus exit block,tachycardia (in SSS), and chronotropic incompetence

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23
Q

Sinus bradycardia is ABNORMAL if

A

HR<40bpm in the awake state in the absence of physical conditioning

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24
Q

This is alternatively defined as failure to-reach 85% of predicted maximal heart rate at peak exercise or failure to achieve a heart rate >100 beats/min with exercise or a maximal heartrate with exercise less than two standard deviations below that of an age-matched control population. Exercise testing may be useful in discriminating chronotropic incompetence from resting bradycardia

A

Failure to increase the heart rate with exercise is referred to as chronotropic incompetence.

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25
The normal IHR after administration of 0.2 mg/kg propranolol and 0.04 mg/kg atropine is ____; a low IHR is indicative of SA disease.
is 117.2 − (0.53 × age) in beats/min
26
Drugs that may be used In AV BLOCK
Atropine 0.5 to 2 mg IV OR ISOPROTERENOL 1-4 ung/min IV
27
Transient abnormality associated with Mobitz type 1 second degree av block:
Inferior wall MI DRUGS (digitalis, CCB, BB) Increased vagal tone
28
Associated with PAROXYSMAL AV BLOCK
Mobitz Type 2 sec degree AV block
29
Typical site of block for Mobitz Type 2 sec degree AV block
Infranodal | Distal or infra-his conduction system
30
The most common arrhythmia identified during extended ECG monitoring
Atrial premature complexes
31
The SIGNITURE tachycardia of patients with significant pulmonary disease
MAT | Multifocal atrial tachycardia
32
Lupus erythematosus like syndrome is commonly seen in slow acetylators of this anti-arrhythmic Agent
PROCAINAMIDE
33
Most common sustained arrhythmia
AF
34
Approach if AF if adequate rate control is not achieved:
Consider restoring to sinus rhythm by CATHETER ABLATION OF AV JUNCTION + placement of PACEMAKER
35
If AF is unclear of <48hours
Anticoagulate before cardio version
36
Underlying condition in AF that necessitates anticoagulantion:
Mitral stenosis Hypertrophic CMP prior history of stroke CHADSVAS SCORE OF >/= 2 (May consider 1)
37
Anticoagulant choice for rheumatic MS or mechanical heart valves in AF
Warfarin (Vitamin k antagonist)
38
Anticoagulant choice for non-valvular AF
Warfarin and direct acting anticoagulants
39
ANTITHROMBIN INHIBITORS | choice for non-valvular AF
Dabigatran
40
Factor Xa inhibitors used in non-valvular AF
Rivaroxaban APIXABAN Endoxaban
41
Avoid dabigatran, rivaroxaban and APIXABAN crea clearance is below
<15cc/min If modest renal impairment just adjust to renal dose
42
True or false: | In AF, IF RECURRENCES ARE INFREQUENT, MAY DO PERIODIC CARDIOVERSION.
True
43
Pharmacotherapy to maintain sinus rhythm or reduce episodes of AF if without significant structural heart disease:
Class IC Sodium channel blocking agents Flecainide Propaferone Disopyramide
44
Pharmacotherapy to maintain sinus rhythm or reduce episodes of AF if with CAD or structural disease:
Class III agents SOTALOL DOFETILIDE
45
More effective drug compared to others as Pharmacotherapy to maintain sinus rhythm or reduce episodes of AF if with CAD or structural disease:
AMIODARONE CLASS III
46
Slightly SUPERIOR compared to DRUG THERAPY for UNTREATED RECURRENT PAROXYSMAL AF
Catheter ablation directed at pulmonic veins foci (less effective fir persistent AF)
47
More effective for PERSISTENT AF than catheter ablation
SURGICAL ABLATION
48
Have wide QRS complexes > 0.12secs | Capable of automaticity, triggered automaticity, reentry thru areas of scar or diseased purkinje system
Ventricular arrhythmias
49
Single ventricular beat that falls earlier than the next anticipated supraventricular beat
PVCs
50
>3 consecutive beats at >100bpm
Vtach
51
Distinguishing time between non sustained Vtach and sustained Vtach
30 seconds
52
Waxing and waning QRS complex
Torsades de pointes
53
PVCs or VTACH in patients without structural heart disease and not associated with genetic syndrome or sudden death
Idiopathic ventricular arrhythmia
54
Anti arrhythmic drug for EIA, IDIOPATHIC ARRHYTHMIA First choice for most ventricular arrhythmia due to safety
Beta blocker
55
Block the delayed rectified potassium channel IKR which: prolongs action potential duration (QT INTERVAL) and cardiac refractory period Predisposes to TORSADES DE POINTES
SOTALOL , DOFETILIDE | K CHANNEL BLOCKERS
56
Most effective anti arrhythmic for ventricular arrhythmia, better than SOTALOL for reducing ICD shocks
AMIODARONE
57
Major adverse effects of AMIODARONE Which | Leads to discontinuation in 1/3 of patients
``` Hyper or Hypothyroidism Pneumonitis or pulmonary fibrosis (PULMONARY INFLAMMATION) Photosensitivity Peripheral neuropathy Ocular toxicity Hepatoxicity ```
58
Major adverse effects of AMIODARONE if given by IV administration for >24 hours via a peripheral vein
SEVERE PERIPHERAL THROMBOPHLEBITIS
59
Highly effective for terminating VT AND VF, decreases mortality of sudden cardiac death
ICD | implantable cardioverter defibrillators
60
Indications for catheter ablation For VT
1. Recurrent (incessant) ventricular arrhythmias associated with poor cardiac function 2. Idiopathic VTach and PVCs without structural heart disease
61
Anti-arrhythmic surgery used for recurrent VT DUE to prior MI, some cases of VT in non-ischemic heart diseaSe
Surgical cryoablation +/- aneurysmectomy
62
Most common origin of idiopathic ventricular arrhythmia
RV OUTFLOW TRACT (LBBB configuration)
63
Structural heart origin in LBBB like configuration
RV or IV septum origin | Dominant S in v1
64
Structural heart origin in RBBB like configuration
LV origin (Dominang R is V1)
65
ECG characteristic of Vtach with inferior wall origin
Negative II III AVF
66
Structural heart origin with ECG: positive II II AVF
Cranial aspect of the heart origin
67
Indication for ICD for survivors of AMI with PVCs or non sustained Vtach (decreases mortality)
>40 days after acute MI + LVEF <0.30 + symptomatic HF (II or III) And >5days after MI + Dec LVEF + non sustained VT + inducible sustained VT or VF on electrophysiological testing
68
PVCs at a rate < 100 beats/min
Idioventricular rhythm
69
ECG CRITERIA | FOR SUSTAINED VENTRICULAR TACHYCARDIA
1. Presence of AV Dissociation 2. Monophasic R wave or Rs complex in AVR 3. Concordance from V1 to V6 of monophasic R or S waves 4. favors SVT: known BBB + same QRS morphology during tachycardia and sinus rhythm
70
≥3 Vtach or vfib episodes within 24hours
Electrical storm or VT storm
71
Management of Electrical storm or VT storm with prolonged QT causing TDP torsades de pointes
IV MAGNESIUM SULFATE
72
Management of Electrical storm or VT storm with Brugada syndrome
QUINIDINE | ISOPROTERENOL
73
The major source of thromboembolism and stroke in AF is formation of thrombus in the _____ where flow is relatively stagnant,although thrombus occasionally forms in other locations as well.
left atrial appendage

MI HARRISSONS (62 decks)

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