Arrhythmia Flashcards
Vaughn williams four classes and examples
Class I - interfere with depolarisation eg flecanide, quinidine
Class II - beta blockade - beta blockers not sotalol
Class III- prolong repolarisation- sotalol and amiodarone
Class IV - calcium channel blockade - verapamil
What does amiodarone do to digoxin?
Increase it
Which statin is not CYP 3A4 metabolised?
Pravastatin
Which antiarrhythmics prolong QTc?
disopyramide procainamide quinidine amiodarone sotalol
Which antipsychotics cause long QTc?
Loads
Which antibiotics?
Macrolides
Metro with alcohol
Moxi
Also fluconazole in cirrhosis
and ketaconazole
And mefloquine
What is a north west axis?
Neg in I and AvF
Pos in AvR
ECG WPW?
Short PR Delta wave LAD if right accessory pathway RAD if left accessory pathway nospec ST/T wave changes
Evidence of use of which aldosterone antagonists for which levels heart fialure?
Rales- spiro- 3-4
Emphasis-HF- epler- 2+
Symptoms and mortality
S4- causes?
Atrial contraction against a stiff ventricle
Aortic stenosis
HOCM- double apical impulse is palpable S4
Hypertension
S3- causes?
Diastolic filling of the LV
Normal under 30
LHF
Constrictive pericarditis
Fixed split S2?
ASD
Soft S2?
AS
Loud S2?
Hypertension
widely split S2?
RBBB
PS
Severe MR
deep inspiration
Draw the cross!
Reverse split S2?
LBBB RV pacing WPW type B PDA Severe AS
Most common symptom in PAH is ?
Exertional dyspnoea
Where should you hear P2?
Only at pulmonic region
only soft
After the A2
Torsades treat?
Magnesium sulphate
What causes torsades?
Anything that prolongs QTc
eg cipro, moxi, hypoK/Mg/Ca, SAH, sotalol, amiodarone, erythromycin
Need both polymorphic VT and long QT to make diagnosis
If you had to combine a beta and calciumc channel blocker, what would you choose?
Nifedipine MR
Marfans- give what drug?
Beta blockers! Also screen their aorta
Most common heart problem in marfans?
Aortic root dilatation 90%
also 75% get MV prolapse
Marfans inheritance
AD
defect in FIBRILLIN-1 gene
What happens to BP in exercise?
Increase systolic
decrease diastolic
increase pulse pressure
How do you know if increase RA pressure is from right heart failure or pulmonary hypertension?
In RH failure not that high- 0-7
Much higher in PAH
SVR =
SVR= 80 x (MAP-CVP) all / CO
PRV=
PVR= 80 x (meanPAP-PCWP)/CO
Cardiac index =
CO/body surface area
On the atrial waveform, what do a,c,x,v,y mean?
a= atrial contraction c= TV closure x= atrial relaxation v= atrial filling and ventricular contraction y= passive atrial emptying
If you saw less than 5mmHg difference between mean RA, RV diastolic, PA diastolic, PCWP, LV diastolic and pericardial pressures, what would you think?
CONSTRICTIVE PERICARDITIS
Normal PA pressure?
15-25 systolic
8-15 diastolic
mean about 16 (10-22 ok)
Differentiate PPAH and VTE causing high pressures?
Classically in PAH have systolic PAP as high as 50!
PE patient would be high but not this high
What does the pulmonary artery occlusion pressure estimate?
LA pressure
AND
if there is no obstruction between LV and LA, extimates LV EDP
Which bit of lung does catheter go in for PCWP?
Zone 3
below LA level
Where Pa>Pc>Pa
has to be zone three because the estimation thing only works for LA pressures when vascular pressures exceed alveolar pressures.
Normal PCWP
6-15
Talk about the lung zones and pressures in each one, comparing, Alveolar pressure, PCWP, and PAP
Zone one at top PA>Pa>Pc Zone Two Pa>PA>Pc Zone three Pa>Pc>PA
Run through what the pressures SHOULD be for the four different things on a right heart cath
RA- 0-7
RV- diastolic 3-12, systolic 15-25
PAP systolic 15-25 diastolic 8-15
PCWP mean 9 range 6-15
What is the gene defect in familial hypercholesterolaemia?
Defect in LDL receptor. Made in golgi but not transported to surface
Why are HDL good?
Pick up cholesterol from cells and transports to liver for partial elimination from body
Also inhibit oxidation of LDL in arterial walls–>ath plaques
What do beta blockers do to your TAG except one?
Push up
except carvedilol
