Braunwalds

Question 1

the most common finding in SCD which can be the first and last manifestation

Answer 1

Coronary heart disease (CHD)

Question 2

Where do you see delta waves?

Answer 2

WPW

Question 3

Where do you see epsilon waves?

Answer 3

ARVC

Question 4

If P waves are notclearly visible on the regular ECG, atrial activity can occasionally be discerned by placing the right and left arm leads in various anterior chest positions. These leads are AKA

Answer 4

(so-called Lewis leads)

Question 5

Definition of frequent PVCs

Answer 5

> 10 per hour

Question 6

Duration of QRS to its peak that makes VT more likely

Answer 6

> = 50 msec

Question 7

How is tilt table testing done

Answer 7

Patients are placed on a tilt table in the supine position and tilted upright to a maximum of 60 to 80 degrees for 20 to 45 minutes or longer if necessary.
Isoproterenol, administered as a bolus or infusion, may
provoke syncope in patients whose initial upright TTT result shows no abnormalities or, after a few minutes of tilt, may shorten the time needed to produce a positive response on the test

Question 8

What type of syncope will test positive in tilt table testing?

Answer 8

neurally mediated
syncope

Question 9

The finding of very long H-V intervals ( _____ msec) identifies patients at increased risk for the development of AV block.

Answer 9

(>80 to 90 msec)

Question 10

Definition of sinus arrhythmia

Answer 10

phasic variation in sinus cycle
length during which the max sinus cycle length minus the min sinus cycle length exceeds 120 msec or the max sinus cycle length minus the min sinus cycle length divided by the min sinus cycle length exceeds 10%

Question 11

Type I AV block with a normal QRS complex almost always takes place at the ______

Answer 11

level of the AV node, proximal to the His bundle

An exception is the uncommon patient with type I intrahisian block.

Question 12

Type II AV block, particularly in association with a BBB, is localized to the ______

Answer 12

His-Purkinje system

Question 13

Gene responsible for LQTS-3

Answer 13

SCN5A

Question 14

In adults, rapid rates may be followed by block (called tachycardia-dependent AV block), which is thought to
result from phase ___ block , postrepolarization refractoriness, and concealed conduction in the AV node.

Answer 14

3

T-achycardia ; T-hree

Question 15

Pause-dependent paroxysmal AV block can also occur; it
results in AV block after a pause or during relative bradycardia. This results from phase __ block

Answer 15

4

P-ause
P-or (4)

Question 16

Neurally-mediated bradyarrhythmias are characterized most frequently by _______

Answer 16

ventricular asystole

caused by cessation of atrial activity as a result of sinus arrest or SA exit block

Question 17

A cardioinhibitory response is generally defined as

Answer 17

ventricular asystole exceeding 3 seconds

Question 18

. A vasodepressor response is usually defined as

Answer 18

a decrease in SBP of 50 mm Hg or more without associated
cardiac slowing or a decrease in SBP exceeding 30 mm Hg when the patient’s symptoms are reproduced

Question 19

Drug that acutely abolishes cardioinhibitory responses to neurally mediated bradyarrhythmias.

Answer 19

Atropine

Question 20

Treatment with the Class IC drug _____ and the Class III drug _____ increased mortality in post-infarct patients, possibly due to proarrhythmic effects

Answer 20

Fleicanide and Sotalol

Question 21

Most likely mechanism of AIVR

Answer 21

Automaticity

Question 22

Condition/s that may present as monomorphic VT and may appear as RBBB when sinus and LBBB morphology when in VT

Answer 22

Repaired TOF, VSD

Question 23

Treatment for Idiopathic LV
fascicular reentrant VT

Answer 23

Beta blocker, verapamil

Question 24

Genes associated with non ischemic cardiomyopathy

Answer 24

40%—LMNA, TTN,
PLM, desmosomal

Question 25

Treatment for catecholaminergic polymorphic VT

Answer 25

Beta blocker, fleicanide

Question 26

The presence of dissociation between ventricular and atrial activity strongly favors VT over SVT, the exception being

Answer 26

junctional ectopic tachycardia with aberrancy

Question 27

Focal VTs tend to be enhanced by beta-adrenergic stimulation. T/F

Answer 27

True Beta-blockers can be helpful and catheter ablation is usually an option when therapy is warranted.

Question 28

Considerations for RVOT VTs

Answer 28

ARVC and cardiac sarcoidosis

Question 29

Treatment for Na blocker toxicity

Answer 29

Hypertonic Na (NaHCO3)

Question 30

Sustained monomorphic VT may present any time after myocardial infarction, but often more than ____ years after the acute infarction

Answer 30

10 Most patients have LV ejection fraction of less than 40%

Question 31

ICDs are also recommended for infarct survivors who are at risk for a first episode of VT based on LV ejection fraction of

Answer 31

35% or less with symptoms of heart failure or less than 30% even in the absence of symptoms provided that they are: (1) at least 40 days from acute infarction and (2) are more than 90 days from a revascularization procedure.

Question 32

Genes assoc with ARVC (autosomal dominant)

Answer 32

Approximately half of the patients have an identifiable mutation involving a esmosomal protein, most commonly plakophilin-2,desmoplakin, and desmoglein, followed by other desmosomal andnon-desmosomal proteins.

Question 33

Treatment for ARVC

Answer 33

Arrhythmias are commonly provoked by exertion. Chronic therapywith a beta-blocker is recommended. An ICD is recommended for those who have had sustained arrhythmias, syncope, or RV or LV dysfunction with ejection fraction of 35% or less, and is considered for patients with less severe manifestations of disease because the initial symptomatic event can be sudden death

Question 34

the most common rhythms identified at sudden death in px with HOCM

Answer 34

Polymorphic VT (PMVT) and VF

Question 35

most common locations for idiopathic VT

Answer 35

RVOT and LVOT

Question 36

mutation assoc with LQTS-1 and 2

Answer 36

Mutation in IK

Question 37

LQTS with broad symmetric t wave

Answer 37

1

Question 38

LQTS with notched or humped t wave

Answer 38

2

Question 39

LQTS with flat ST segment with a peaked T-wave

Answer 39

3

Question 40

Treatment for LQTS

Answer 40

beta blocker Chronic beta-blocker therapy with propranolol or nadolol is often sufficient, particularly for type 1 and 2 LQTS; metoprolol is less effective. Specific therapeutic strategies for the type of LQTS are emerging, including potassium supplementation for type 2 and sodium channel blockers for type 3

Question 41

Syndromes assoc with LQTS

Answer 41

(Timothy Syndrome, AndersenTawil Syndrome) and a recessive form accompanied by congenital deafness (Jervell Lange-Nielsen Syndrome)

Question 42

Mutations assoc with Short QTc

Answer 42

It is rare and caused by mutations that result in gain of function in repolarizing potassium channels (IKr and IKs) or loss of function in the L-type calcium current channel Most patients present with arrhythmias before 40 years of age. There is a male predominance. An ICD is recommended for patients who have had symptomatic arrhythmias. Quinidine may be helpful in diminishing episodes of VT

Question 43

For Brugada syndrome, ____ the only established therapy to protect against SCD and is recommended for patients with a history of cardiac arrest or syncope consistent with an arrhythmia who have a type-1 ECG

Answer 43

ICD

Question 44

Definition of early repolarization pattern

Answer 44

An ER pattern is defined as a J-point elevation (or a J-wave producing slurring of the terminal QRS) ≥1 mm in at least 2 contiguous inferior and/or lateral leads of the 12-lead ECG and a QRS duration less than 120 milliseconds in leads without J waves

Question 45

Bidirectional VT is also seen in ______ (3)

Answer 45

digoxin toxicity, myocarditis, and Anderson-Tawil syndrome

Question 46

Definition of lone AF

Answer 46

Lone atrial fibrillation refers to AF that occurs in patients younger than 60 years who do not have hypertension or any evidence of structural heart disease

Question 47

Percentage of asymptomatic AF

Answer 47

25%

Question 48

AF burden in persistent AF

Answer 48

100%

Question 49

Aside from prior stroke, the highest RR for stroke among best-established risk factors for stroke in patients with nonvalvular AF is ______

Answer 49

DM (relative risk [RR], 1.7), hypertension (RR, 1.6), heart failure (RR, 1.4), and age 70 or older (RR, 1.4 per decade)

Question 50

reversal agent of dabigatran

Answer 50

idarucizumab

Question 51

reversal agent for Factor X inhibitors

Answer 51

andexanet alfa

Question 52

Onset of DOACs, half life of DOAC

Answer 52

1.5-2h 12hrs

Question 53

The most common oral agents for acute conversion of AF are

Answer 53

propafenone (300 to 600 mg) and flecainide (100 to 200 mg)

Question 54

Definition of early persistent AF

Answer 54

<6 months

Question 55

optimal metric for rate control is a resting heart rate

Answer 55

<80 beats/min

Question 56

all the available drugs except amiodarone have similar efficacy and are associated with a _____ reduction in the odds of recurrent AF during 1 year of treatment

Answer 56

40% to 60% amiodarone was 60% to 70% more effective in suppressing AF

Question 57

The risk of developing AF increases ___ with every 5-point increase in BMI.

Answer 57

29%

Question 58

The goal of weight loss ideally should be a BMI of

Answer 58

≤27 kg/m

Question 59

Most common site of focal trigger that initiate AF

Answer 59

pulmonary vein

Question 60

Most feared complication of AF ablation

Answer 60

atrial esophageal fistula

Question 61

The only proven benefit of AF ablation

Answer 61

improvement in QoL

Question 62

incidence of AF after open heart surgery can be significantly reduced by prophylactic

Answer 62

Amiodarone, Sotalol, Btea blockers

Question 63

electrolyte imbalance common after open heart surgery and can heigten the risk of AF

Answer 63

Hypomagnesemia

Question 64

AF that occurs after cardiac surgery often resolves within _____

Answer 64

3 months

Question 65

______ and _____ are contraindicated in patients with WPW syndrome and AF

Answer 65

Digitalis and calcium channel antagonists These agents selectively block conduction in the AV node and can result in acceleration of conduction through the accessory pathway.

Question 66

The most appropriate rate-control drugs in patients with systolic heart failure are _____ and ______

Answer 66

beta blockers and digitalis.

Question 67

the only two rhythm-control drugs that are not associated with an increased risk of death in patients with heart failure

Answer 67

Amiodarone and dofetilide

Question 68

AF occurs in ___% of px with HOCM

Answer 68

25%

Question 69

Adequate HR cntrol of px with AF during moderate exercise

Answer 69

90-115

Question 70

interpret HUT result

Answer 70

POTS

Question 71

interpret HUT result

Answer 71

Cardioinhibitory

Question 72

interpret HUT result

Answer 72

Vasodepressor

Question 73

interpret HUT result

Answer 73

Mixed

Question 74

interpret HUT result

Answer 74

Autonomic failure

Question 75

interpret HUT result

Answer 75

normal

Question 76

Only indication for treatment of PAC

Answer 76

if sufficiently symptomatic

Question 77

Least common mechanism of PSVT

Answer 77

FAT

Question 78

Narrowest anatomic segment of the circuit travelled by typical atrial flutter

Answer 78

Cavo-Tricuspid Isthmus

Question 79

Antiarrhythmics that should not be used in px with atrial flutter

Answer 79

Class 1 C due to risk of slowing atrial rate and facilitating 1:1 Av conduction

Question 80

Cut off for classifying Short RP tachycardias

Answer 80

RP <70 msec vs > 70 msec

Question 81

Pseudo RBBB in v1 and pseudo S in inferior leads indicate _____ with accuracy of 100%

Answer 81

typical AVNRT

Question 82

Most common mechanism for SVT in adults late after surgical repair of CHD

Answer 82

Macroreentrant AT

Question 83

Medications that will inc pacing threshold

Answer 83

Amiodarone Class 1C

Question 84

Medications that will lower pacing threshold

Answer 84

Glucocorticoids Isoproterenol and Epinephrine

Question 85

Tachycardia detection duration should be programmed to at least _____ seconds or at ____ interval

Answer 85

6-12 30

Question 86

For primary prevention in adult patients, the slowest tachycardia detection rate should be programmed to

Answer 86

185 to 200 beats/min.

Question 87

Antitachycardia pacing (ATP) should be programmed for all VT/ventricular fibrillation (VF) zones up to _____ beats/min in all patients with structural heart disease.

Answer 87

230

Question 88

In which type of surgeries should you apply magnet in px with Pacemaker/ICD

Answer 88

Apply magnet or reprogram if surgical site above umbilicus.

Question 89

Guidelines for ICD patients recommend that patients refrain from driving for ___ months after each shock for VT/VF and for __ months after ICD implant for secondary prevention.

Answer 89

6 6