Arrhythmias

Question 1

Clinical uses of beta-blockers for arrhythmias

Answer 1

-arrhythmias involving catecholamines
-atrial arrhythmias
-post-MI prevention of ventricular arr.
-prophylaxis in long-QT syndrome

Question 2

Clinical uses of Ca channel blockers for arrhythmias

Answer 2

-block re-entrant arrhythmias involving AV node
-protect ventricular rate in atrial flutter/Afib

Question 3

What part of the heart creates the heart rate?

Answer 3

SA node

Question 4

AFib Stage 3A =

Answer 4

paroxysmal - intermittent and terminates within ≤ 7 days of onset

Question 5

AFib Stage 3B =

Answer 5

persistent - continuous and sustains for > 7 days and requires intervention

Question 6

AFib Stage 3C

Answer 6

long-standing persistent = continuous for > 12 months

Question 7

AFib Stage 3D =

Answer 7

successful ablation - freedom from AF after percutaneous or surgical intervention

Question 8

AFib stage 4 =

Answer 8

permanent afib - no further attempts at rhythm control

Question 9

Afib symptoms

Answer 9

palpitations, dizziness, fatigue, lightheadedness, SOB, hypotension, syncope, angina

Question 10

Oral anticoagulants are recommended for patients with Afib and CHADS-VASC score of… (men and women)

Answer 10

men: ≥ 2
women: ≥ 3

Question 11

Warfarin in ONLY preferred for afib patients when….

Answer 11

-patient has mechanical heart valve
-afib is associated with heart valve disease

otherwise DOAC is preferred

Question 12

Warfarin or apixaban is preferred in what patients with afib?

Answer 12

end-stage CKD (CrCl < 15)
or
hemodialysis

Question 13

What afib drugs for ventricular rate control have direct AV node inhibition?

Answer 13

-diltiazem
-verapamil
-beta-blockers
-digoxin

Question 14

What 5 drugs are used for conversion to sinus rhythm?

Answer 14

-amiodarone
-ibutilide
-procainamide
-flecainide
-propafenone

Question 15

What 6 drugs are used for maintenance of sinus rhythm?

Answer 15

-amiodarone
-dofetilide
-dronedarone
-sotalol
-propafenone
-flecainide

Question 16

Amiodarone adverse effects (6)

Answer 16

-hypo/hyperthyroidism
-hepatotoxicity
-QT interval prolongation
-pulmonary fibrosis
-corneal microdeposits
-derm: blue/grey skin, photosensitvity

Question 17

Describe SVT

Answer 17

regular rhythm
narrow QRS complexes
HR = 110-225 BPM
spontaneous initiation and termination

Question 18

What drugs are used for termination of SVT?

Answer 18

adenosine
B-blockers
verapamil + diltiazem

Question 19

What is the MOA for the drugs used for termination of SVT?

Answer 19

-inhibit AV node conduction
-terminates re-entrant pathway

Question 20

What does VFib look like on an ECG?

Answer 20

irregular, disorganized electrical activity - no recognizable QRS complexes

Question 21

The only effective treatment for Vfib is….

Answer 21

defibrillation
(drugs are only used to facilitate defibrillation, will not terminate Vfib alone)

Question 22

Clinical features of Afib

Answer 22

Rhythm is irregularly irregular
P wave absent
No atrial depolarizations
Ventricular rate = 120-180bpm

Question 23

Afib mechanisms

Answer 23

abnormal atrial/pulmonary vein automaticity
atrial reentry

Question 24

supraventricular tachycardia predominant mechanism of reentry

Answer 24

AV node (60%)

Question 25

Clinical features of ventricular tachycardia

Answer 25

regular rhythm
wide QRS complexes (PVCs) ≥ 3 consecutively
HR > 100 bpm