arrhythmia

Question 0

When is the relative refractory period?

Answer 0

Late phase 3 and early phase 4

Question 1

SA node resting rate
AV node resting rate
bundle branch escape rate

Answer 1

SA: 60-100
AV: 40-60
BB: 20-40

Question 2

Arrhythmias caused by early after depolarizations

Answer 2

Torsade des Pointe

Tachycardia

Question 3

Reentry arrhythmias

Answer 3

AVNRT 
AVRT
WPW syndrome
Atrial flutter
Atrial fib
Ventricular tach
Ventricular fib

Question 4

Class I anti-tach agents

MOA

Answer 4

Na+ channel blockers, thus reducing Vmax of depolarization
Ia: all heart rates (Quinidine, Procainamide)
Ib: little effect on slow rates, effect increased on faster rates, does not decrease Action Potential duration (lidocaine)
Ic: all heart rates, minimal effect on AP duration (flecainide)

Question 5

Class II anti-tach agents

Answer 5

B-blockers
decrease SA node automaticity
increase AV node refractoriness
decrease AV node conduction velocity
(propranolol, metoprolol)

Question 6

Class III anti-tach agents

Answer 6

Potassium channel blockers
Prolong AP duration
(amiodarone)

Question 7

Class IV anti-tach agents

Answer 7

Calcium channel blockers
decreases conduction velocity
increases refractoriness
(verapamil)

Question 8

Class I indications

Answer 8

Ia: less used
Ib: v tach
Ic: v tach or supra-ventricular tach

Question 9

Class II indications

Answer 9

Metoprolol (selective)

for hypertension/coronary artery disease associated tach

Question 10

Class III indication

Answer 10

Amiodarone: coronary artery disease and heart failure patients

Question 11

Class IV indications

Answer 11

superaventricular tach

Question 12

Anti-bradycardia agents

Answer 12

Isoprenaline
Epinephrine
Atropine
Aminophylline

Question 13

Which anti-tach drugs can cause arrhythmias?

Answer 13

Ia and Ic: can cause VT or VF
III

II, IV can cause bradycardia

Question 14

Best treatment for sick sinus syndrome?

Answer 14

Pacemaker since drug treatment is not responsive

Question 15

Treatment for atrial flutter

Answer 15

Treatment of underlying 
Restore rhythm: cardioversion,cardioablasion, class Ia or Ic or III

Control ventricular rate: CCB, Bblocker, anti-coag

Question 16

Atrial fib has danger of developing

Answer 16

Stroke, thus prevention of embolism is #1 goal of treatment

Question 17

Digitalis toxicity most likely cause this type of arrhythmia

Answer 17

Nonparoxysmal AV junctional tach

Question 18

PVST (paroxysmal supra ventricular tach) due to what cause

Answer 18

REENTRY
90% due to AVNRT
10% from AVRT

Question 19

Therapy for paroxysmal tach

Answer 19

for nodal RT, increase vagal tone by carotid sinus massage or valsalva maneuver.
Or verapamil, adenosine

Question 20

Wolf Parkinson White

MOA

Answer 20

Anterograde conduction over accessory pathway that bypasses the AV node, may lead to ventricular tach

Question 21

WPW treatment

Answer 21

cardioaversion
DO NOT USE DIGOXIN OR CCB because these cause VT
use drugs that prolong refractory period
Ia,Ic,III,IV

Question 22

What drugs should be avoided in ventricular premature contractions (PVC)

Answer 22

Ic agents because they can cause arrhythmias

Question 23

Events that cause Torsades de Pointes

Answer 23

hypokalemia
prolongation of AP duration
early after depolarizations
slow conduction that contributes to reeentry

Question 24

Treatment of VT

Answer 24

cardioversion (for unstable VT of when drugs have no effect)
B-blockers (II)
Lidocain (Ib)
amiodarone(III)

Question 25

Pattern for second degree AV block (type I)

location of block

Answer 25

aka Mobitz type I aka Wenckebach

it’s a gradual elongation of PR interval until a a beat is dropped
location is the AV node (commonly)

Question 26

secondary degree AV block type II pattern

location

Answer 26

aka Mobitz II

constant PR intervals preceding a dropped beat
His bundle is most common site

Question 27

Routine lab tests for hypertension

Answer 27

Blood glucose
Serum K and Ca (hyperparathyroid)
Creatinine in urine (test GFR)
Lipoprotein 
EKG

Question 28

Microalbuminuria tests for what?

Answer 28

Diabetic nephropathy