Arrhythmias

Question 1

Tx of unstable bradycardia

Answer 1

1. Atropine (vagolytic)

2. Epinephrine, dopamine (positive chronotropic)

Question 2

Tx of unstable tachycardia

Answer 2

Synchronized cardioversion

Amiodarone, beta-blocker, lidocaine

Question 3

Tx of Orthodromic Parxoysmal Supraventricular Tachycardia

(Wide/Narrow) complex?

Answer 3

1. Vagal maneuver
2. adenosine
3. beta-blockers, CCB
   Unstable –> synchronized cardioversion
   Sustained –> catheter ablative sx

Narrow

Question 4

WPW has ___ waves, (narrow/wide) QRS, (long/short) PRI.

What accessory pathway?

Answer 4

Delta, wide QRS, short PRI

Kent Bundle

Question 5

Tx of WPW

Answer 5

Vagal maneuver
Procainamide*, Amiodarone
Radiofrequency ablation = definitie tx

Question 6

MC rhythm seen in digitalis toxicity

Answer 6

AV junctional dysrhythmia

Question 7

Atrial fibrillation
Rate:
Medication rate control: (w/ and w/o HF)

Answer 7

350-600 bpm
Rate control:
W/ HF: digoxin, amiodarone, dronedarone
w/o HF: beta-blocker (metroprolol, esmolol), CCB (diltiazem, verapamil)

Cardioversion after 3-4 weeks of anticoag or TEE showing no atrial thrombi

Question 8

Atrial flutter MC seen in ___

Answer 8

COPD

Question 9

Atrial flutter
Rate:
Medication rate control:

Answer 9

250-350 bpm
beta-blocker (metroprolol, esmolol), CCB (diltiazem, verapamil)
Cardioversion if unstable
Radiofrequency ablation = definitive tx

Question 10

What electrolyte abnormalities associated w/ Torsades de pointes?

Tx?

Answer 10

Hypomagnesemia
Hypokalemia

Tx: IV magnesium

Question 11

Recurrent syncope, QT interval 0.5-0.7s long, ventricular arrhythmias, sudden death =

Answer 11

Long QT syndrome

Question 12

Syncope, ventricular fibrillation, sudden death during sleep. Common in ___

Answer 12

Brugada syndrome

Asian men

Question 13

Tx of acute V tach

Answer 13

1. amiodarone
2. lidocaine
3. procainamide

Question 14

What kind of heart block?
Constant prolonged PRI –> dropped QRS

Tx?

Answer 14

Mobitz II (2nd degree AV block)

Tx: Permanent pacemaker

Question 15

What kind of heart block?
Progressive prolonged PRI –> dropped QRS

Tx?

Answer 15

Mobitz I/Wenckebach (2nd degree AV block)

Tx: atropine, epinephrine, +/- pacemaker

Question 16

Multifocal atrial tachycardia is associated w/

Answer 16

severe COPD

HR > 100 bpm + 3 P wave morphologies

Question 17

Wandering atrial pacemaker =

Multifocal atrial tachycardia =

Answer 17

Wandering atrial pacemaker = HR < 100 bpm + 3 P wave morphologies

Multifocal atrial tachycardia = HR > 100 bpm + 3 P wave morphologies

Question 18

Alcohol excess or alcohol withdrawal precipitates this kind of arrhythmia

Answer 18

Atrial fibrillation

Question 19

Match Antiarrythmic drug class to its action

1. Beta-blockers, slow AV conduction
2. Slow calcium channel blockers
3. Shorten repolarization
4. Na channel blockers, depress phase 0 depolarization, slow conduction, prolong repolarization
5. Depress phase 0 repolarization, slow conduction
6. Potassium channel blockers, prolong action potential
7. Slow conduction through AV node, interrupts reentry pathway
8. Direct action on cardiac mm and indrect action on CV system via ANS

Ia, Ib, Ic, II, III, IV, V

Answer 19

1. II: esmolol, propranolol, metoprolol
2. IV: verapamil, diltiazem
3. Ib: lidocaine, mexiletine
4. Ia: quinidine, procainamide, disopyramide, moricizine
5. Ic: Flecainide, propafenone
6. III: Amiodarone, sotalol, dofetilide, ibutilide
7. V: Adenosine
8. V: Digoxin

Question 20

Treatment of symptomatic bradycardia

Answer 20

First Line: atropine.
Second: epinephrine
Permanent: Permanent pacemaker