arrhythmias Flashcards

Question

congenital short QT syndrome

Answer 1

very rare caused by mutation in cardiac K+ channels may be assoc with AF may present in young kids - most dont survive very malignant

Answer 2

inherited channelopathy risk of polymorphic VT, VF AF commoon 12 assoc genes autosomal dominant adults, 8x more common in males also if previous cardiac arrest

Answer 3

ST elevation + RBBB in V1-V3 ECG finfing may be intermittent + change over time changes may only be seen with provocative testing -> flecanide or ajmaline - drugs that block the cardiac sodium channel

Answer 4

usually rest or sleep fever excessive alcohol, large meals genotype + fam history of sudde cardiac death DOES NOT influence prognosis

Answer 5

lifestyle - avoid drugs that induce ST elevation in right leads -- anti-arrhythmis drugs -- psychotropics -- analgesics -- anaesthetics - avoid excessive alcohol + large meals - prompt treatment of any fever with paracetamol ICD implantation if - survived aborted cardiac arrect - documented spontaneous sustained VT - considered is spontaneous type I ECG pattern + history of syncope

Answer 6

adrenergic induced bidirectional + polymorphic VT, SVTs triggered by emotional stress of physical physical activity 1 in 1000 at rest, normal ECG + ECHO autosomal dominant + recessive

Answer 7

lifestyle - avoid competitive sports, strenous exercise, stressful environments beta blockers for all - consider for genetically positive family members even after negative exercise test ICD implantation +/- flecainide - for patients who experient recurrent syncope, cardiac arrest, polymorphic/bidirectional VT despite optimal therapy

Answer 8

accessory pathway connecting atria to ventricles (bundle of kent) - usually only one pathway -> SA node small risk of sudden cardiac death (SCD)

Answer 9

radiofrequency ablation of accessory pathway

Answer 10

common mutation in sarcomere gene that codes for development of cardiac muscle

Answer 11

40-60% sarcomeric protein gene mutation Anderson-Fabry mitochondrial diseases neuromuscular disease amyloidosis new-born of diabetic mother drug induced - tacrolimu, hydroxycholoquine, teroids

Answer 12

varies massively sudden death heart failure end stage heart failure atrial fibrillation syncope following exercise jerky pulse, double apex beat ejection systolic murmur

Answer 13

avoid competitive sports ICD implantation in patient who have survived cardiac arrest due to VT or VF evaluate 5yr risk every 1-2yrs

Answer 14

occurs when fibro-fatty replacement of cardiomyocytes - fatty deposits in RV wall - current travels around the fat causing reentry VT LV involvement in >50%

Answer 15

autosomal dominant mutations in genes from desmosomal proteins autosomal recessive mutation in nondesmosomal genes around 50% of patients have a mutation of one of the several genes which encode components of desmosome (variable expression)

Answer 16

1st - beta blockers(sotalol) - titrated to max tolerated dose - amiodarone if not tolerated ICD implantation catheter ablation avoid competitive sports ICD depends on risk of SCD - fam history of premature SCD - severity of RV + LV function - frequent non-sustained VT - ECG = QRS widening - male - age of presentation

Answer 17

ECG - abnormalities in V1-3, typically T wave inversion - epsilon wave is found in about 50% - best described as a terminal notch in the QRS complex ECHO - often subtle in early stages but may show an enlarged, hypokinetic right ventricle with a thin free wall MRI useful to show fibrofatty tissue

Answer 18

nitrates ACEi inotropes

Answer 19

classic findings of heart failure systolic murmur - stretching of valves may cause mitral + tricuspid regurgitation S3 "balloon" appearance on CXR