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Cards > Arrhythmia > Flashcards

Arrhythmia Flashcards

1
Q

Vaughn williams four classes and examples

A

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

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2
Q

What does amiodarone do to digoxin?

A

Increase it

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3
Q

Which statin is not CYP 3A4 metabolised?

A

Pravastatin

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4
Q

Which antiarrhythmics prolong QTc?

A 
disopyramide
procainamide
quinidine
amiodarone
sotalol
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5
Q

Which antipsychotics cause long QTc?

A

Loads

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6
Q

Which antibiotics?

A

Macrolides
Metro with alcohol
Moxi

Also fluconazole in cirrhosis
and ketaconazole

And mefloquine

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7
Q

What is a north west axis?

A

Neg in I and AvF

Pos in AvR

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8
Q

ECG WPW?

A 
Short PR
Delta wave
LAD if right accessory pathway
RAD if left accessory pathway
nospec ST/T wave changes
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9
Q

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

A

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

Symptoms and mortality

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10
Q

S4- causes?

A

Atrial contraction against a stiff ventricle

Aortic stenosis
HOCM- double apical impulse is palpable S4
Hypertension

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11
Q

S3- causes?

A

Diastolic filling of the LV

Normal under 30
LHF
Constrictive pericarditis

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12
Q

Fixed split S2?

A

ASD

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13
Q

Soft S2?

A

AS

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14
Q

Loud S2?

A

Hypertension

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15
Q

widely split S2?

A

RBBB
PS
Severe MR
deep inspiration

Draw the cross!

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16
Q

Reverse split S2?

A 
LBBB
RV pacing
WPW type B
PDA
Severe AS
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17
Q

Most common symptom in PAH is ?

A

Exertional dyspnoea

18
Q

Where should you hear P2?

A

Only at pulmonic region
only soft
After the A2

19
Q

Torsades treat?

A

Magnesium sulphate

20
Q

What causes torsades?

A

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

Need both polymorphic VT and long QT to make diagnosis

21
Q

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

A

Nifedipine MR

22
Q

Marfans- give what drug?

A

Beta blockers! Also screen their aorta

23
Q

Most common heart problem in marfans?

A

Aortic root dilatation 90%

also 75% get MV prolapse

24
Q

Marfans inheritance

A

AD

defect in FIBRILLIN-1 gene

25
Q

What happens to BP in exercise?

A

Increase systolic
decrease diastolic
increase pulse pressure

26
Q

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

A

In RH failure not that high- 0-7

Much higher in PAH

27
Q

SVR =

A

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

28
Q

PRV=

A

PVR= 80 x (meanPAP-PCWP)/CO

29
Q

Cardiac index =

A

CO/body surface area

30
Q

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

A 
a= atrial contraction
c= TV closure
x= atrial relaxation
v= atrial filling and ventricular contraction
y= passive atrial emptying
31
Q

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

A

CONSTRICTIVE PERICARDITIS

32
Q

Normal PA pressure?

A

15-25 systolic
8-15 diastolic

mean about 16 (10-22 ok)

33
Q

Differentiate PPAH and VTE causing high pressures?

A

Classically in PAH have systolic PAP as high as 50!

PE patient would be high but not this high

34
Q

What does the pulmonary artery occlusion pressure estimate?

A

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

35
Q

Which bit of lung does catheter go in for PCWP?

A

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.

36
Q

Normal PCWP

A

6-15

37
Q

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

A 
Zone one at top
PA>Pa>Pc
Zone Two
Pa>PA>Pc
Zone three
Pa>Pc>PA
38
Q

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

A

RA- 0-7

RV- diastolic 3-12, systolic 15-25

PAP systolic 15-25 diastolic 8-15

PCWP mean 9 range 6-15

39
Q

What is the gene defect in familial hypercholesterolaemia?

A

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

40
Q

Why are HDL good?

A

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

41
Q

What do beta blockers do to your TAG except one?

A

Push up

except carvedilol

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