Arrhythmias Flashcards
Swimming
Young
SCD
Long QT type 1
IKs mutation
Loss of function in K channel
Common Mechanism of VT in CAD
Re-entry circuit, scar-mediated
Outflow tract VT mechanism
Delayed afterdepolarizations
No ICD
Mgmt of Type 1 brugada vs Type 2 or 3
ICD
EPS if syncope
Class I indication ICD
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
Class III ICD
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
VT mechanism in Torsades and LQTS
VT mechanism in Digoxin toxicity
Early afterdepolarization
Delayed afterdepolarization
Other medications that can’t be used with dofetilide
HCTZ
Verapamil
Many others but less commonly used
Amiodarone interactions
Increases digoxin, Coumadin and cyclosporine
*need to reduce Coumadin dose by half when starting amio
Adenosine dose in transplant patient
1 mg..if you do it.
No absolute contraindication
Procainamide toxicity
NAPA accumulation (a metabolite) that occurs with renal dysfunction
Prolongs QTc
New use-dependent AV block, possibly with exercise or increased sympathetic tone. What drug could cause this?
Propafenone or Flecainide
Orthodromic
Antidromic
Down conduction system, up accessory
Down accessory, up conduction system (wide QRS)
Valvular AF definition
Mod to severe Mitral stenosis Or
Mechanical heart valve
Preferred AAD for HCM
Amio or disopyramide
Can also use sotalol, dofetilide or dronedarone
Post surgical AFib preferred drugs
BB or CCB first (Class I)
AAD or DCCV second
PMVT mechanism
Early afterdepolarization
Brugada syndrome
Cause
Indications for ICD
Loss of function sodium channel (SCN5A) in 25%
Aborted cardiac event
Syncope + ECG pattern
Asx + positive EPS
Class I agents
Ia - 3
Ib - 2
Ic - 2
Effects
Quinidine, procainamide, disopyramide
Lidocaine, mexilitene
Flecainide, propafenone
All blunt phase 0, Ia lengthen QRS and QT, Ib shorten QT, and Ic lengthen QRS
Mechanism of VT with class III agents?
With digoxin toxicity or CPVT?
Early after delop
Delayed after depol
First line for Afib in CAD
Dofetilide or
Sotalol
Amio second line
Not Ic agents
In structural heart dz:
Meds for MMVT
PMVT
BB, Amio
Sotalol (unless CHF)
BB, lido, amio
PMVT in normal hearts, treat with what?
LQTS
CPVT
Brugada
BB
Flecainide
Quinidine
Do not use ICD for these things
5
WPW Outflow Tract VT VT/VF within 48 hr of MI VT from drugs or electrolytes CPVT (usually)
