Arrhythmias IV Flashcards
WCT + AV dissociation = ?
VT
WCT + concordance= ?
VT
what does dig tox VT look like on EKG?
narrow complex
what does SVT due to drugs look like on EKG?
WCT
RBBB> ? = VT
140ms
LBBB>? = VT
160ms
WCT with R - in I and F = ?
VT
what does the presence of negative concordance in WCT rule out?
antidromic tachycardia
WCT w/ broad, slurred, notched QRS= ?
VT
WCT w/ atypical RBBB/LBBB = ?
VT
R/S ratio < 1 in V6 w/ WCT = ?
VT
QS in V6 w/ WCT = ?
VT
criteria for LBBB
- QRS > 120ms
- broad monomorphic R in I, V6 w/o Q waves
- broad monomorphic S in V1, may have small R
criteria for RBBB
- QRS>120 ms
- Slurred S in I, V6
- RSR’ in V1 w/ R’>R
Brugada Algorithm
- No RS in precordial leads
- R-S>100ms in one precordial lead
- AV dissociation
- VT Morphology in V1-V2
Sn and Sp of AV dissociation for VT
Sn 82%
Sp 98%
Sn and Sp for No RS in precordial leads for VT (Brugada)
Sn 21%
Sp 100%
Sn and Sp for R-S>100ms for VT (Brugada)
Sn 21%
Sp 100%
Sn and Sp for VT if morphology criteria are met in Brugada algorithm
Sn 99%
Sp 97%
aVR criteria for VT
- presence of R wave
- r or q > 40ms
- if QRS -, should be a notch on descending limb
what will the HV interval be on an EPS for SVT w/ aberrancy?
normal
lidocaine dosing for VT
1mg/kg bolus + .5mg/kg gtt after 5 mins
procainamide dosing for VT
20-50 mg/min bolus
watch for hypotension
can you use adenosine for acute Rx of VT?
yes
can you use BB, CCB or Dig in acute Rx of VT?
No
name a good drug for VT,SVT, or preexcitation
procainamide
antiarrhythmic Rx for out of hospital arrest (VT)
amio
antiarrhythmic for ischemic VT
lidocaine
4 drugs you can use for acute VT Rx
lidocaine
amio
adenosine
procainamide
does cardiac sarcoid predispose to SCD?
yes
does infiltrative CM predispose to SCD?
yes
most common cause of SCA in young people?
HCM
what can MVP syndrome cause?
SCD
Catecholaminergic VT
defect in calcium handling (RYR2/CASQ2 genes)
- exercise induced polymorphic VT
LQT1
swimming
Rx BB
ICD if SCA/syncope
LQT2
Sound (alarm clocks)
Rx: BB
LQT3
sleep
channels involved in LQT1,2,3.
LQT1: Ks
LQT2: Kr
LQT3: Na (gain of fxn)
classic EKG finding in Brugada syndrome
IRBBB w/ ST Elevation
most common mech of arrhythia causing SCD in structural heart disease?
reentry
if exertional syncope, think of?
Cathecholaminergic VT
Rx: BB, verapamil or ICD
AVID trial
Amio vs ICD in Secondary Prevention of SCD
>30%mortality reduction at 3 yrs w/
EF< 35% benefited most
what is the only good risk stratifier for SCD in CAD pt’s?
Decreased LVEF
which trial was stopped early and showed benefit of ICD over OMT in pts w/ prior MI and EF<30% ?
MADIT II
Trial that showed pt’s w/ ICM or NICM and Class II or III HF had decreased mortality with ICD but not w/ Amio in Primary Prevention of SCD.
SCD-HeFT
Trial that showed Amio = Placebo in SCD Primary Prevention
SCD-HeFT
which two trials are the US guidelines for ICD usein primary prevention? what do they use for risk stratification?
MADIT II
SCD-HEFT
LVEF
Which trial is the basis for ICD use in secondary prevention?
AVID
How manu joules of stored energy does an ICD keep?
34J
*what is the most common cause for ICD giving inappropriate shocks?
atrial arrhythmias (like afib)
how long after an I with EF<35% can you put in ICD?
40d
which trial made ICD Class I indication for prior MI/EF< 40%/NSVT/inducible VT?
MUSTT
Does CRT-D decrease both morbidity and mortality?
yes(COMPANION)
can VT be irregular in the beginning of an EKG?
yes
what does a superior “northwest” axis of -90 to +/- 180 (towards aVR) strongly suggest?
VT
acute Rx of unstable VT
DC SYNCHRONIZED shock
Brugada syndrome mech
loss of fxn of SCN5A
Clinical presentation of Brugada
syncope after fever or illmess
most common arrhythmia seen with Brugada syndrome
VF
can you put an ICD into a pt with prior MI (>40d), LVEF <40%, NSVT and inducible VT?
yes, Class I, MUSST
name two arrhythmias causing VF/VT that are amenable to surgery or ablation and are Class III for ICD placement
WPW + RVOT/LVOT VT
