Arrhythmias

Question 1

Swimming
Young
SCD

Answer 1

Long QT type 1
IKs mutation
Loss of function in K channel

Question 2

Common Mechanism of VT in CAD

Answer 2

Re-entry circuit, scar-mediated

Question 3

Outflow tract VT mechanism

Answer 3

Delayed afterdepolarizations

No ICD

Question 4

Mgmt of Type 1 brugada vs Type 2 or 3

Answer 4

ICD

EPS if syncope

Question 5

Class I indication ICD

Answer 5

Survivor of cardiac arrest from VF or HD unstable VT (excluding reversible causes)

Structural heart disease and spontaneous sustained VT, HD stable or not

Syncope of undetermined origin and HD significant VT or VF on EP study

Other structural syndromes

Primary prevention
NICM , <35% class II to III
ICM , <35% class II to III, over 40 days after MI
ICM , class I and <30%
Prior Mi NSVT and sustained VT/VF on EP study

Question 6

Class III ICD

Answer 6

Survival < 1 year

Incessant VT or VF

Psychiatric illness that may be aggravated by it

NYHA class IV , drug refractory HF

VF/VT amenable to ablation (WPW, RVOT or LVOT VT)

Syncope from undetermined cause

VT/VF from other completely reversible causes

Question 7

VT mechanism in Torsades and LQTS

VT mechanism in Digoxin toxicity

Answer 7

Early afterdepolarization

Delayed afterdepolarization

Question 8

Other medications that can’t be used with dofetilide

Answer 8

HCTZ
Verapamil
Many others but less commonly used

Question 9

Amiodarone interactions

Answer 9

Increases digoxin, Coumadin and cyclosporine

*need to reduce Coumadin dose by half when starting amio

Question 10

Adenosine dose in transplant patient

Answer 10

1 mg..if you do it.

No absolute contraindication

Question 11

Procainamide toxicity

Answer 11

NAPA accumulation (a metabolite) that occurs with renal dysfunction

Prolongs QTc

Question 12

New use-dependent AV block, possibly with exercise or increased sympathetic tone. What drug could cause this?

Answer 12

Propafenone or Flecainide

Question 13

Orthodromic

Antidromic

Answer 13

Down conduction system, up accessory

Down accessory, up conduction system (wide QRS)

Question 14

Valvular AF definition

Answer 14

Mod to severe Mitral stenosis Or

Mechanical heart valve

Question 15

Preferred AAD for HCM

Answer 15

Amio or disopyramide

Can also use sotalol, dofetilide or dronedarone

Question 16

Post surgical AFib preferred drugs

Answer 16

BB or CCB first (Class I)

AAD or DCCV second

Question 17

PMVT mechanism

Answer 17

Early afterdepolarization

Question 18

Brugada syndrome

Cause

Indications for ICD

Answer 18

Loss of function sodium channel (SCN5A) in 25%

Aborted cardiac event
Syncope + ECG pattern
Asx + positive EPS

Question 19

Class I agents

Ia - 3
Ib - 2
Ic - 2

Effects

Answer 19

Quinidine, procainamide, disopyramide

Lidocaine, mexilitene

Flecainide, propafenone

All blunt phase 0, Ia lengthen QRS and QT, Ib shorten QT, and Ic lengthen QRS

Question 20

Mechanism of VT with class III agents?

With digoxin toxicity or CPVT?

Answer 20

Early after delop

Delayed after depol

Question 21

First line for Afib in CAD

Answer 21

Dofetilide or
Sotalol

Amio second line

Not Ic agents

Question 22

In structural heart dz:

Meds for MMVT

PMVT

Answer 22

BB, Amio
Sotalol (unless CHF)

BB, lido, amio

Question 23

PMVT in normal hearts, treat with what?

LQTS
CPVT
Brugada

Answer 23

BB
Flecainide
Quinidine

Question 24

Do not use ICD for these things

5

Answer 24

WPW
Outflow Tract VT
VT/VF within 48 hr of MI
VT from drugs or electrolytes
CPVT (usually)