Braunwalds Flashcards
the most common finding in SCD which can be the first and last manifestation
Coronary heart disease (CHD)
Where do you see delta waves?
WPW
Where do you see epsilon waves?
ARVC
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
(so-called Lewis leads)
Definition of frequent PVCs
> 10 per hour
Duration of QRS to its peak that makes VT more likely
> = 50 msec
How is tilt table testing done
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
What type of syncope will test positive in tilt table testing?
neurally mediated
syncope
The finding of very long H-V intervals ( _____ msec) identifies patients at increased risk for the development of AV block.
(>80 to 90 msec)
Definition of sinus arrhythmia
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%
Type I AV block with a normal QRS complex almost always takes place at the ______
level of the AV node, proximal to the His bundle
An exception is the uncommon patient with type I intrahisian block.
Type II AV block, particularly in association with a BBB, is localized to the ______
His-Purkinje system
Gene responsible for LQTS-3
SCN5A
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.
3
T-achycardia ; T-hree
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
4
P-ause
P-or (4)
Neurally-mediated bradyarrhythmias are characterized most frequently by _______
ventricular asystole
caused by cessation of atrial activity as a result of sinus arrest or SA exit block
A cardioinhibitory response is generally defined as
ventricular asystole exceeding 3 seconds
. A vasodepressor response is usually defined as
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
Drug that acutely abolishes cardioinhibitory responses to neurally mediated bradyarrhythmias.
Atropine
Treatment with the Class IC drug _____ and the Class III drug _____ increased mortality in post-infarct patients, possibly due to proarrhythmic effects
Fleicanide and Sotalol
Most likely mechanism of AIVR
Automaticity
Condition/s that may present as monomorphic VT and may appear as RBBB when sinus and LBBB morphology when in VT
Repaired TOF, VSD
Treatment for Idiopathic LV
fascicular reentrant VT
Beta blocker, verapamil
Genes associated with non ischemic cardiomyopathy
40%—LMNA, TTN,
PLM, desmosomal
Treatment for catecholaminergic
polymorphic VT
Beta blocker, fleicanide
The presence of dissociation between ventricular and atrial activity strongly favors VT over SVT, the exception being
junctional ectopic tachycardia with aberrancy
Focal VTs tend to be enhanced by beta-adrenergic stimulation.
T/F
True
Beta-blockers can be helpful
and catheter ablation is usually an option when therapy is warranted.
Considerations for RVOT VTs
ARVC and cardiac sarcoidosis
Treatment for Na blocker toxicity
Hypertonic Na (NaHCO3)
Sustained monomorphic VT may present any time after myocardial infarction, but often more than ____ years after the acute infarction
10
Most patients have LV ejection fraction of less than 40%
ICDs are also recommended for infarct survivors who are at risk for a first episode of VT based on LV ejection fraction of
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.
Genes assoc with ARVC (autosomal dominant)
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.
Treatment for ARVC
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
the most common rhythms identified at sudden death in px with HOCM
Polymorphic VT (PMVT)
and VF
most common locations for idiopathic VT
RVOT and LVOT
interpret HUT result
POTS
interpret HUT result
Cardioinhibitory
interpret HUT result
Vasodepressor
interpret HUT result
Mixed
interpret HUT result
Autonomic failure
interpret HUT result
normal
