Arrhythmia

Question 1

Vaughn williams four classes and examples

Answer 1

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

Question 2

What does amiodarone do to digoxin?

Answer 2

Increase it

Question 3

Which statin is not CYP 3A4 metabolised?

Answer 3

Pravastatin

Question 4

Which antiarrhythmics prolong QTc?

Answer 4

disopyramide
procainamide
quinidine
amiodarone
sotalol

Question 5

Which antipsychotics cause long QTc?

Answer 5

Loads

Question 6

Which antibiotics?

Answer 6

Macrolides
Metro with alcohol
Moxi

Also fluconazole in cirrhosis
and ketaconazole

And mefloquine

Question 7

What is a north west axis?

Answer 7

Neg in I and AvF

Pos in AvR

Question 8

ECG WPW?

Answer 8

Short PR
Delta wave
LAD if right accessory pathway
RAD if left accessory pathway
nospec ST/T wave changes

Question 9

Evidence of use of which aldosterone antagonists for which levels heart fialure?

Answer 9

Rales- spiro- 3-4
Emphasis-HF- epler- 2+

Symptoms and mortality

Question 10

S4- causes?

Answer 10

Atrial contraction against a stiff ventricle

Aortic stenosis
HOCM- double apical impulse is palpable S4
Hypertension

Question 11

S3- causes?

Answer 11

Diastolic filling of the LV

Normal under 30
LHF
Constrictive pericarditis

Question 12

Fixed split S2?

Answer 12

ASD

Question 13

Soft S2?

Answer 13

AS

Question 14

Loud S2?

Answer 14

Hypertension

Question 15

widely split S2?

Answer 15

RBBB
PS
Severe MR
deep inspiration

Draw the cross!

Question 16

Reverse split S2?

Answer 16

LBBB
RV pacing
WPW type B
PDA
Severe AS

Question 17

Most common symptom in PAH is ?

Answer 17

Exertional dyspnoea

Question 18

Where should you hear P2?

Answer 18

Only at pulmonic region
only soft
After the A2

Question 19

Torsades treat?

Answer 19

Magnesium sulphate

Question 20

What causes torsades?

Answer 20

Anything that prolongs QTc
eg cipro, moxi, hypoK/Mg/Ca, SAH, sotalol, amiodarone, erythromycin

Need both polymorphic VT and long QT to make diagnosis

Question 21

If you had to combine a beta and calciumc channel blocker, what would you choose?

Answer 21

Nifedipine MR

Question 22

Marfans- give what drug?

Answer 22

Beta blockers! Also screen their aorta

Question 23

Most common heart problem in marfans?

Answer 23

Aortic root dilatation 90%

also 75% get MV prolapse

Question 24

Marfans inheritance

Answer 24

AD

defect in FIBRILLIN-1 gene

Question 25

What happens to BP in exercise?

Answer 25

Increase systolic decrease diastolic increase pulse pressure

Question 26

How do you know if increase RA pressure is from right heart failure or pulmonary hypertension?

Answer 26

In RH failure not that high- 0-7 | Much higher in PAH

Question 27

SVR =

Answer 27

SVR= 80 x (MAP-CVP) all / CO

Question 28

PRV=

Answer 28

PVR= 80 x (meanPAP-PCWP)/CO

Question 29

Cardiac index =

Answer 29

CO/body surface area

Question 30

On the atrial waveform, what do a,c,x,v,y mean?

Answer 30

``` a= atrial contraction c= TV closure x= atrial relaxation v= atrial filling and ventricular contraction y= passive atrial emptying ```

Question 31

If you saw less than 5mmHg difference between mean RA, RV diastolic, PA diastolic, PCWP, LV diastolic and pericardial pressures, what would you think?

Answer 31

CONSTRICTIVE PERICARDITIS

Question 32

Normal PA pressure?

Answer 32

15-25 systolic 8-15 diastolic mean about 16 (10-22 ok)

Question 33

Differentiate PPAH and VTE causing high pressures?

Answer 33

Classically in PAH have systolic PAP as high as 50! | PE patient would be high but not this high

Question 34

What does the pulmonary artery occlusion pressure estimate?

Answer 34

LA pressure AND if there is no obstruction between LV and LA, extimates LV EDP

Question 35

Which bit of lung does catheter go in for PCWP?

Answer 35

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.

Question 36

Normal PCWP

Answer 36

6-15

Question 37

Talk about the lung zones and pressures in each one, comparing, Alveolar pressure, PCWP, and PAP

Answer 37

``` Zone one at top PA>Pa>Pc Zone Two Pa>PA>Pc Zone three Pa>Pc>PA ```

Question 38

Run through what the pressures SHOULD be for the four different things on a right heart cath

Answer 38

RA- 0-7 RV- diastolic 3-12, systolic 15-25 PAP systolic 15-25 diastolic 8-15 PCWP mean 9 range 6-15

Question 39

What is the gene defect in familial hypercholesterolaemia?

Answer 39

Defect in LDL receptor. Made in golgi but not transported to surface

Question 40

Why are HDL good?

Answer 40

Pick up cholesterol from cells and transports to liver for partial elimination from body Also inhibit oxidation of LDL in arterial walls-->ath plaques

Question 41

What do beta blockers do to your TAG except one?

Answer 41

Push up | except carvedilol