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Arrhythmias Flashcards

1
Q

Time course of VPCs from birth to adults

A

Commonly occur in infancy.; declines in incidence in early childhood
Becomes common again in adolescence and adulthood

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2
Q

Ventriculophasic Sinus arrhythmias

A

The 2 p waves sorrounding a QRS occurs at a faster rate
Exact reason not known
?increased SA nodal artery flow

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3
Q

How to identify a WPW with long refractory period

A

Intermittent loss of delta ; at rest or exercise or with procainamide

Chances of Afib with fast conduction less

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4
Q

First step in Arruda algorithm For WPW

A 
Two leads
V1& Ld 1
Ld 1::Isoelectric or neg DELTA-Left free wall path
OR
V1::R/S more than 1-Left free wall

To locate more precisely check DELTA in
aVF-positive::LL/LAL
Negative::LP/LPL

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5
Q

Most common type of WPW

A

LEFT LATERAL

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6
Q

Second step in Arruda for WPW

A

Coronary Sinus step

Negative DELTA in Ld II ( mimics IWMI)

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7
Q

SVT originates from

A

HIS bundle and above

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8
Q

Cardiac compromise happens when heart rate is more than

A

200/mt i.e. < 300 ms

60000ms/300ms=200

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9
Q

Atypical AVNRT is precipitated by —-ectopics

A

Ventricular

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10
Q

Long RP tachy means

A

RP> PR

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11
Q

Irregular SVT

A

AF,MAT,AFlutter with varying condxn

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12
Q

Atrial tachy is Short or Long RP

A

Usually Long RP. Or if Short RP , the short RP >90 ms

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13
Q

Epicardium mapping in VT is indicated in structural diseases like

A

CHAGAS

ARVD

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14
Q

Frequent VPCs definition

A
  1. More than 60/ hour or 1/minute -ESC cardiology

2. >1% or > 1000 per day- Korean heart journal

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15
Q

ECG findings which suggest Brugada syndrome in an asymptomatic type 1 pattern

A

1.First degree heart block
2.Left axis deviation
Late potential in SAE,
3. Afib
4. ST/T alternans with VPCs of LBBB morphology in Holter
5. Fragmented QRS

BLAST Fragmented the QRS

2013 Criteria for Asymptomatic Pts

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16
Q

Use of family history in diagnosis of BRUGADA SYNDROME

A
  1. Family history of SCD <45 yrs

2. Type 1 ECG pattern in family - This was there in 2005 criteria but removed in 2013 criteria

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17
Q

In pts with WPW and AF higher risk is suggested by persistence of accessory pathway conduction with RR intervals

A

Less than 250ms

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18
Q

SCD in apparently normal hearts incidence

A

5-20%

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19
Q

In Lowns grading of VPB Ron T is

A

Grade 5 . Most severe

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20
Q

Lowns grading of Multifocsl VPBs

A

Grade3

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21
Q

Lowns grading of couplets and NSVT

A

Grade 4

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22
Q

Location of carotid Sinus is b/w

A

Angle of mandible and Superior border of Thyroid cartilage

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23
Q

What direction of current do V1/2 measure

A

Anterior/Posterior forces

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24
Q

Right/Left forces are measured by which leads

A

V6, Lead I

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25
Q

If all frontal plane leads are isoelectric the axis is

A

Cannot be determined i.e. Indeterminate.. This is a normal variant

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26
Q

Antidote of adenosine

A

Aminophylline

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27
Q

Location of carotid Sinus

A

Inferior to angle of mandible at level of Thyroid cartilage

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28
Q

ACC/AHA/HRS definition of Non valvular Afib 2014 Jan

A

In the absence of

  1. Rheumatic MITRAL VALVE DISEASE
  2. Mitral valve repair
  3. Prosthetic valve
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29
Q

AV Search hysteresis is

A

AV delay is periodically lengthened for upto 8 consecutive beats to search for intrinsic PR intervals

Useful for pts with intermittent AV block

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30
Q

MVP mode of pacing

A

Managed Ventricular Pacing

Uses AV Search hysteresis

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31
Q

Primary mode of Pacing in MVP Mode is

A

AAIR

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32
Q

Heart rate is said to be regular if the RR variability is

A

Less than 60 ms

Internet

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33
Q

Step 3 if Arruda algorithm (Septal step)

A

V1 lead negative or equiphasic delta

aVF -positive means AS or MS . (anteroseptal or mid septal ) if axis >0 AS & if < 0 MS

Now remaining is PS( posteroseptal)- if aVF delta is equiphasic it is LPS; if negative it is RPS

After this step the remaining will be Right free wall

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34
Q

WQRS tachy showing indeterminate axis but not VT occurs in setting of

A

WPW with antidromic conduction

Bi ventricular pacing- shows a q in Ld I

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35
Q

An axis change of ______indicates VT

A

40 degree

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36
Q

An axis of ____ with RBBB indicates VT

A

-30 or more

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37
Q

An axis of _____indicates VT in LBBB

A

90 or more

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38
Q

A QRS duration of> ______ indicates VT in RBBB

A

140

In LBBB it is 160

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39
Q

How to differentiate WPW(antidromic) vs VT

A

Check V4,5,6– If predominantly negative VT

If not check for q in V2,3,4,5,6 - if present VT

If not look for 1:1 conduction- if present not VT

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40
Q

3 features of AV dissociation in VT

A
  1. Dissociated p waves
  2. Fusion beats
  3. Capture beats
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41
Q

Morphological criteria in V6 for VT with RBBB

A

rS in V6 . s/o VT

If R/s is more than 1 it’s SVT

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42
Q

Morphological criteria for VT with LBBB in V6

A

qR pattern in V6

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43
Q

Anterior fascicle supplies which part of LV

A

ALU–Anterior supplies LATERAL and UPPER parts

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44
Q

Short QT syndrome QT interval

A

360 or less

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45
Q

How to evaluate Short QT syndrome

A

330 ms or greater & no clinical criteria- no evaluation

Less than 330 (Markedly short QT)and no clinical criteria- EP reference for genetic screening etc

<350 and clinical criteria need ICD

Clinical-VT,Syncope, AF , Family history etc

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46
Q

MC type of LQTS

A

Type 1

Deafness is a feature

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47
Q

Triggers for LQTS

A

LQTS1- Exercise

LQTS2- Loud noise

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48
Q

Pause dependence in LQTS means

A

Ectopic-Pause-next QT will be prolonged- now if another ectopic happens Torsades is ppted

Long -Short cycle

Common in LQTS2

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49
Q

Paroxysmal Afib means

A

Reverts in 7 days

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50
Q

Main risk of sub clinical Hyperthyroidism

A

Afib

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51
Q

VKA was proven superior to Aspirin for stroke prevention in AF in

52
Q

VKA was shown to reduce stroke in Afib by 2/3 rd versus placebo in

53
Q

Dabigatran in Afib trial was published in

54
Q

Around …..% of patients with Afib have concomitant ACS

55
Q

Donperidone should not be prescribed if QTc is more than

A

Males 450

Females 470

56
Q

Most common cause of cardiac arrest in young adults

A
  1. HCM

2. Anomalous origin of Coronary Arteries

57
Q

Castle AF trial results

A

In AF and EF <=35NYHA II or more with CRT— Catheter ablation superior to Drugs

58
Q

Average heart rate in Inappropriate Sinus Tachy in 24 hr Holter

A

> 95

Other sources> 90/my

59
Q

Effect of beta blockers in IST ( inappropriate Sinus tachy)

A

Generally ineffective even in high doses.

Can try Ivabradine also

60
Q

POTS (postural orthostatic tachycardia syndrome)

A

Persistent increase in heart rate by >30 beats/mt or HR > 120/ mt within 10 mts of upright position without orthostatic hypotension

61
Q

P waves may be difficult to see when HR is more than

62
Q

Agent for acute treatment of SVT in pregnancy

A

Adenosine

2nd Metoprolol

3rd Verapamil

4th Procainamide

5th Amiodarone when no other options .Multiple adverse effects on fetus

63
Q

Role of eyeball pressure in SVT

A

Abandoned - dangerous

64
Q

Cardioversion in pregnancy

A

Reported to be safe in all stages of pregnancy

2015 ACC/AHA. SVT Guidelines

65
Q

Ongoing treatment of SVT in pregnancy

A

Digoxin, Metoprolol, Propranolol- considered safe first line agents

Beta blockers- intrauterine growth retardation. Especially with Atenolol

Flecainide And Propafenone has been used in maternal and fetal arrhythmias

66
Q

Drug treatment of AVRT with pre excitation in resting ECG

A

Flecainide or Propafone- in absence of Struct heart disease
IIa indication

Class I is ablation

Class IIb is Amiodarone, Sotolol etc or even beta blockers/CCB

67
Q

Focal atrial tachy 3 features

A
  1. 100-250/mt rate
  2. Isoelectric segment in between
  3. Microreentry or Automaticity
68
Q

Atrial flutter is otherwise can be called as

A

Macro reentry Atrial tachy

69
Q

2 types of TYPICAL Atrial flutter

A

Clockwise- Positive P in infr leads and Negative in V1

Counterclockwise- Opposite pattern

V1 is opposite polarity to infr leads

Normal ECG type is clockwise

70
Q

Atypical Atrial Flutter is different from typical by

A

Atypical is not Cavotrcuspid isthmus dependent

Usually secondary to Atrial scars due prior surgery etc

71
Q

ECG finding in atypical Atrial flutter

A

Does not fit Typical flutter findings

Eg- P wave polarity can be concordant in infr and V1 unlike typical

72
Q

Arrhythmia originating from His Bundle is

A

SVT. by definition

Not VT

73
Q

Atypical AVNRT forms …..% of AVNRT

74
Q

In typical AVNRT antegrade conduction is via the

A

Slow pathway

75
Q

Common sites of WPW in order

A
  1. Left lateral-50%
  2. Posteroseptal-30%
  3. Right anteroseptal and Rt lateral-10% each
76
Q

Short PR interval is

77
Q

Pacemaker mediated tachycardia is due to

A

Sensing of retrograde p wave as intrinsic p

78
Q

Blanking period is to prevent

A

Oversensing and cross talk

79
Q

Two parts of refractory period in Pacemaker

A

Refractory period

First part of refractory period- no sensing- blanking period
Second part of refractory period-relative refractory-senses But no pacing

80
Q

Difference in time interval between Sensed and Paced AV intervals

A

Paced AV interval is usually 30 seconds more than Sensed AV interval

The interval b/w Sensed or Paced p and V pace

81
Q

Ventricular refractory period is to prevent

A

T wave oversensing

82
Q

Pacemaker mediated tachycardia can be prevented by

A

Increasing PVARP-Post Ventricular Atrial Refractory Period

Sensing retrograde P is prevented by Ventricular blanking . During rest of the refractory period it senses but will not initiate the AV delay

83
Q

During BLANKING period there is No—

84
Q

How to measure QTc in Afib

A
  1. QT after longest and shortest RR divided by the square root of preceding RR
  2. QTc of 10 beats

No final decision

85
Q

Wide QRS adjusted QTc

A

QTc-(QRS-100)

86
Q

Feature of Second degree SAN block Type 1

A

PP shortening gradually
So grouping of QRS happens
Pause at end of each group

Look like Sinus arrhythmia

In Type I block pause is less than 2 PP interval

87
Q

Second degree Type II SA block ECG feature

A

Pause sorrounding dropped P is an exact multiple of preceding PP interval

88
Q

What Sinus pause is significant

A

A pause of 3 second or more is generally considered to be significant

Pause of 2 seconds may be considered normal

89
Q

Sinus pause definition is

A

2 seconds or more

> 3 is mostly significant

90
Q

Treatment of Asymptomatic Sinus node disease

A

No treatment

91
Q

When is Sinus arrhythmia considered abnormal

A

Only in Digoxin toxicity sinus arrhythmia is considered normal

92
Q

Post Atrial ventricular blanking means

A

After Atrial pacing Ventricle is deaf /blind for some time. ie it will not sense anything

Done to prevent Atrial pacing being detected by Ventricular lead , which will inhibit ventricular pacing and is catastrophic

So Yes if a Ventricular extra systole happens during this period it will not be detected and there is a chance of ventricular pacing occurring during the vulnerable period

93
Q

Post Atrial ventricular blanking period is usually programmed to ….. ms

94
Q

How is risk of pacing on a Ventricular extra systole at the vulnerable period ( relative refractory period)after the p wave is prevented

A

After Post Atrial Ventricular Blanking period there is a period called Safety Window where Ventricular activity is Sensed.

If Ventricular activity is Sensed the AV delay is automatically shortened so that the Ventricular pacing will happen early in the refractory period of the extra systole ( and not in relative refractory period- the vulnerable period)

Also if the activity detected is not a real QRS the Ventricle will be paced - thus giving a safety option

95
Q

The duration of safety window in Ventricular lead is

A

110 ms or identical as the AV delay if AV delay is less than 110 ms

So after the Post Atrial Ventricular blanking period of 30-40 ms… if the ventricular lead senses an activity the AV delay is shortened so that pacing doesn’t happen on the vulnerable period of QRS at the end of normal AV delay

96
Q

What is Hysteresis in VVI Pacemaker

A
  1. It’s a rate which is set lower than the lower rate of pacing
  2. Eg. If lower pacing rate is 60. Then Hysteresis will be set lower than 60. Eg at rate of 50
  3. Once the pacemaker senses an intrinsic QRS , it then waits for a longer time than before to check whether some intrinsic activity is going to occur at 50/mt.
  4. If the next intrinsic comes within 1200 ms. ( ie at 50/my)It will not pace.
  5. Once it starts pacing it paces again at 1000ms interval(60/mt)
97
Q

In 2013 consensus statement how many leads are required to make diagnosis of Brugada

A

Only one lead
V1 or V2

Uses the BLAST Fragmented QRS criteria in Asymptomatic patients

First degree AV block and LAD in ECG, Late potentials, Atrial fibrillation, ST/T alternans

2005 criteria used family history of Type I Ecg as a criteria

98
Q

The PR interval following an interpolated VPC may be prolonged because

A

Of the concealed retrograde conduction into the AV node

99
Q

The cardiac vein which travels along with LAD

A

Great cardiac vein

100
Q

Parasystole occurs because of

A

Entrance block into the ectopic site. So it cannot be influenced

101
Q

Beta blockers with Most supporting evidence in Afib

A

Atenolol, Metoprolol, Timolol, Pindalol, Nadolol

Though most appear to have similar efficacy . Labetolol may be little less effective in reducing heart rate at rest

102
Q

Brugada Syndrome there is no real RBBB because it’s a

A

Repolarisation abnormality and not a depolarization abnormality like RBBB

103
Q

MC use of SAECG

A

To detect Ventricular Late potentials. (rePresent delayed ventricular activation ) .

Identifies patients at increased risk of re-entrant re-entrant ventricularTachyarrhythmia

Can also be used to find Atrial late potentials- among other uses

104
Q

Role of aspirin in prosthetic valves

A

75-100 mg in all mechanical prosthesis- Class 1A

IIaB in bio prosthetic valves

105
Q

Isoprenaline reduces QTc so is useful in

A

Torsades/ Polymorphic VT

106
Q

Short PR interval with normal QRS

A

Lown Ganong Levine syndrome

107
Q

———million people worldwide have Afib

A

33 million

108
Q

2017 EMANATE trial

A

Apixaban safe as routine anticoagulants in Elective cardioversion of AFib

109
Q

Most common sustained cardiac arrhythmia

110
Q

First Randomised study to show LAA closure during surgery reduces stroke

A

2017 LAACS study

111
Q

SA Node is situated in

A

RA/ POSTERIOR WALL/ Near Entrance of SVC

112
Q

AV Node is situated in

A

RA/ Lower portion of IAS/ Just above the SEPTAL CUSP of TV/ Anterior to Ostium of CORONARY SINUS - ie in the Triangle of Koch

113
Q

Conduction through which bundle is little slower

A

RIGHT BUNDLE is slower than LEFT

114
Q

Course of His bundle

A

Pass through fibrous trigone- Along upper portion of membranous IVS( here divides into Rt and Lt)

Rt extends into subendocardial layer of IVS

Lt bundle emerges in LV (passing through upper part of Muscular IVS- ) between RCC& NCC

115
Q

The WIDTH & HEIGHT of ………….wave is same in adults and children

A

P wave

Both less than 2.5 mm in Adults and children

116
Q

The 2 congenital long QTc syndromes

A
  1. Jervell Lange Nielsen syndrome

2. Romano Ward syndrome

117
Q

For Bazett equation how to measure RR interval

A

RR interval just prior to the measured QT interval is taken

118
Q

Lon QTc as a normal variant is seen in

A

Sleep

Marked Sinus arrhythmia

119
Q

Rule of thumb for QT INTERVAL

A

At normal rates if 60-100, QTc should be less than half the RR interval

120
Q

Intendations on T indicate

A
  1. Pwave or

2. T/U combination

121
Q

QTc interval indicates

A

total duration of electrical activity of the Ventricles

122
Q

Percentage of patients having visual symptoms with Ivabradine

123
Q

ST prolongation contributing to QT prolongation is characteristic of

A

Hypocalcemia

124
Q

Minimum Duration of Afib to diagnose it

A

Min 30 seconds- ESC 2016

125
Q

Sinus pause definition

A

2 seconds or more

Uptodate

126
Q

Sinus node exit block identification

A

First degree- cannot be differentiated from Normal
Third degree- cannot be differentiated from SINUS ARREST

Second degree- TYPE2- Pause PP interval is a multiple of basic PP interval

TYPE1- pp progressively REDUCES.Then pause. Pause is less than 2 Times PP interval

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