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Arrhythmia > Braunwalds > Flashcards

Braunwalds Flashcards

1
Q

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

A

Coronary heart disease (CHD)

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2
Q

Where do you see delta waves?

A

WPW

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3
Q

Where do you see epsilon waves?

A

ARVC

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4
Q

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

A

(so-called Lewis leads)

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5
Q

Definition of frequent PVCs

A

> 10 per hour

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6
Q

Duration of QRS to its peak that makes VT more likely

A

> = 50 msec

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7
Q

How is tilt table testing done

A

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

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8
Q

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

A

neurally mediated
syncope

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9
Q

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

A

(>80 to 90 msec)

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10
Q

Initial dose of atropine for bradycardia

A

0.5 mg

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11
Q

Definition of sinus arrhythmia

A

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%

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12
Q

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

A

level of the AV node, proximal to the His bundle

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

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13
Q

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

A

His-Purkinje system

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14
Q

Gene responsible for LQTS-3

A

SCN5A

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15
Q

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.

A

3

T-achycardia ; T-hree

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16
Q

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

A

4

P-ause
P-or (4)

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17
Q

Neurally-mediated bradyarrhythmias are characterized most frequently by _______

A

ventricular asystole

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

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18
Q

A cardioinhibitory response is generally defined as

A

ventricular asystole exceeding 3 seconds

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19
Q

. A vasodepressor response is usually defined as

A

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

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20
Q

Drug that acutely abolishes cardioinhibitory responses to neurally mediated bradyarrhythmias.

A

Atropine

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21
Q

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

A

Fleicanide and Sotalol

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22
Q

Most likely mechanism of AIVR

A

Automaticity

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23
Q

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

A

Repaired TOF, VSD

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24
Q

Treatment for Idiopathic LV
fascicular reentrant VT

A

Beta blocker, verapamil

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25
Q

Genes associated with non ischemic cardiomyopathy

A

40%—LMNA, TTN,
PLM, desmosomal

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26
Q

Treatment for catecholaminergic
polymorphic VT

A

Beta blocker, fleicanide

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27
Q

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

A

junctional ectopic tachycardia with aberrancy

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28
Q

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

T/F

A

True

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

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29
Q

Considerations for RVOT VTs

A

ARVC and cardiac sarcoidosis

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30
Q

Treatment for Na blocker toxicity

A

Hypertonic Na (NaHCO3)

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31
Q

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

A

10

Most patients have LV ejection fraction of less than 40%

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32
Q

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

A

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.

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33
Q

Genes assoc with ARVC (autosomal dominant)

A

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.

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34
Q

Treatment for ARVC

A

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

35
Q

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

A

Polymorphic VT (PMVT)
and VF

36
Q

most common locations for idiopathic VT

A

RVOT and LVOT

37
Q

mutation assoc with LQTS-1 and 2

A

Mutation in IK

38
Q

LQTS with broad symmetric t wave

A

1

39
Q

LQTS with notched or humped t wave

A

2

40
Q

LQTS with flat ST segment with a peaked T-wave

A

3

41
Q

Treatment for LQTS

A

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

42
Q

Syndromes assoc with LQTS

A

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

43
Q

Mutations assoc with Short QTc

A

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

44
Q

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

A

ICD

45
Q

Definition of early repolarization pattern

A

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

46
Q

Bidirectional VT is also seen in ______ (3)

A

digoxin toxicity, myocarditis, and Anderson-Tawil syndrome

47
Q

Definition of lone AF

A

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

48
Q

Percentage of asymptomatic AF

A

25%

49
Q

AF burden in persistent AF

A

100%

50
Q

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

A

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)

51
Q

reversal agent of dabigatran

A

idarucizumab

52
Q

reversal agent for Factor X inhibitors

A

andexanet alfa

53
Q

Onset of DOACs, half life of DOAC

A

1.5-2h

12hrs

54
Q

The most common oral agents for acute conversion of AF are

A

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

55
Q

Definition of early persistent AF

A

<6 months

56
Q

optimal metric for rate control is a resting heart rate

A

<80 beats/min

57
Q

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

A

40% to 60%

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

58
Q

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

A

29%

59
Q

The goal of weight loss ideally
should be a BMI of

A

≤27 kg/m

60
Q

Most common site of focal trigger that initiate AF

A

pulmonary vein

61
Q

Most feared complication of AF ablation

A

atrial esophageal fistula

62
Q

The only proven benefit of AF ablation

A

improvement in QoL

63
Q

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

A

Amiodarone, Sotalol, Btea blockers

64
Q

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

A

Hypomagnesemia

65
Q

AF that occurs after cardiac surgery often resolves within _____

A

3 months

66
Q

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

A

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.

67
Q

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

A

beta blockers and digitalis.

68
Q

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

A

Amiodarone and dofetilide

69
Q

AF occurs in ___% of px with HOCM

A

25%

70
Q

Adequate HR cntrol of px with AF during moderate exercise

A

90-115

71
Q

interpret HUT result

A

POTS

72
Q

interpret HUT result

A

Cardioinhibitory

73
Q

interpret HUT result

A

Vasodepressor

74
Q

interpret HUT result

A

Mixed

75
Q

interpret HUT result

A

Autonomic failure

76
Q

interpret HUT result

A

normal

77
Q

Only indication for treatment of PAC

A

if sufficiently symptomatic

78
Q

Least common mechanism of PSVT

A

FAT

79
Q

Narrowest anatomic segment of the circuit travelled by typical atrial flutter

A

Cavo-Tricuspid Isthmus

80
Q

Antiarrhythmics that should not be used in px with atrial flutter

A

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

81
Q

Cut off for classifying Short RP tachycardias

A

RP <70 msec vs > 70 msec

82
Q

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

A

typical AVNRT

83
Q

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

A

Macroreentrant AT

Arrhythmia (13 decks)

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