Cvs Flashcards
1
Q
Plateu phase is seen in Pacemakers or myocardial cells
A
Myocardial cells
2
Q
Effective refractory period In action potential of myocardial cell
A
200msec
3
Q
Effective refractory period In nerve fibre cell is
A
2 to 4 msec
4
Q
Nerve can be tatanized while myocardial cell cannot be tetanised because of difference in what
A
Effective Refractory period
5
Q
RMP of Myocardial Cell is
A
-85 mV
6
Q
Depolarisation in myocardial cells is due to
A
Influx of Na
7
Q
Phase 0 in myocardial cell Action potential is due to
A
Influx of Na
8
Q
Which phases are completely above 0 mV in myocardial cell action potential
A
Phase 1 and phase 2
9
Q
Phase 1 in myocardial action potential is due to
A
Potassium efflux
10
Q
Which phase is transient repolarisation In Myocardial Cell action potential
A
Phase 1
11
Q
Potassium moves out of myocardial cell in which phases
A
Phase 1phase 2 phase 3
12
Q
In phase 2 which iron in flux occurs in myocardial action potential
A
Calcium influx
13
Q
Why is plato formed in phase two of myocardial action potential
A
Due to influx of calcium ions and efflux of potassium ions
14
Q
Two ions neutralise each other in myocardial action potential in which phase ?
Which two ions?
A
In phase two
Calcium and potassium
15
Q
Which ion involved in phase three of myocardial action potential
A
Potassium efflux
16
Q
Phase 4 of myocardial action potential is dominated by which ion
A
Potassium
17
Q
Which is resting phase in myocardial action potential
A
Phase 4
18
Q
Most important feature in pacemaker action potential is
A
It has to do automatic depolarisation
19
Q
Phase four is not resting in which action potential myocardial or pacemaker
A
Pacemaker action potential has non resting phase 4
20
Q
Funny current are seen in which phase of which action potential
A
Phase four of pacemaker action potential
21
Q
Which channels are involved in phase 4 of pacemaker action potential
A
1 Mixed ion channels for Na And K
2 T type calcium channels
22
Q
If( Na and K ) MIXED Channels are activated by?
A
Hyperpolarization and cAMP
23
Q
If( Na and K ) Are type of which channels
A
HCN 4
Hyperpolarization activated cyclic nucleotide channels
24
Q
If( Na and K ) Are fast or slow channels
A
slow
25
What are structures with least speed of conduction and why
Nodes
SA node and AVN
Because of slow channels If( Na and K )
26
Cardiac structures As per Speed of conduction in decreasing order
His perkinje bundle
Atria
Ventricles
AVN
27
Fastest speed of conduction in Cardiac pacemaker cells is
HIS purkinje fibres
28
Mnemonic 'Park at ventura avenue'for
speed of Conduction in cardiac Pacemakers cells
29
Pneumonic for phase 4 channel in pacemaker action potential
Funny CAT
30
Type of Calcium channel in phase 0 Of pacemaker action potential
L type
SLOW type
31
Phase 4 of pacemaker action potential Till what membrane potentials
-40mV
32
which iron channels dominate phase three of pacemaker action potential
Potassium
33
Which ion channels dominate phase one of pacemaker action potential
Calcium L type
34
How many faces and what number in pacemaker action potential
Three phases
phase 4 phase 0 phase 3
35
How does Acetylcholine act on Pacemaker cell action potential
Slow down phase 4
Decrease rate of conduction at AV node
36
How does Adenosine act on pacemaker action potential
Slow down phase 4
Decreases rate of conduction at AV node
37
How does Catecholamines act on pacemaker action potential
Fasten phase 4
Increase rate of conduction at AV node
38
How does Cakcium Channel blockers act on pacemaker action potential
Slow down phase 4
It decreases Rate of conduction in AV node
39
How does Beta blocker act on pacemaker action potential
Slow down phase 4
It decreases Rate of conduction in AV node
40
How does Parasympathetic systemact on pacemaker action potential
Slow down phase 4
It decreases Rate of conduction in AV node
41
What type of calcium channel blockers a slowdown pacemaker action potential phase 0
Non DHP
Verapamil
Diltiazim
42
WPW bypasses which structure
AV Node
43
What happened to WPW bundle when conduction of AV node is decreased
More current will pass through WPW Bundle
44
Which drugs are contraindicated in WPW syndrome
All drugs that decreases rate of conduction in AV node
Acetylcholine
adenosine
beta blockers
calcium channel blockers parasympathomimetic?
45
Drugs that decrease rate of conduction of AV node are DOC in which condition
Acetylcholine adenosine beta blockers calcium channel blockers parasympathomimetics?
PSVT
46
AV Node re entrant circuit is seen in
AVRT
PSVT
47
Which drugs are helpful in AVRT
Acetylcholine
Adenosine
beta blockers
calcium channel blockers parasympathomatics
48
Von/ won classification for which drugs
Anti Arhythmics
49
Which channels are blocked in class one anti arrythmics
Sodium channels are blocked
50
Which slope goes down in all class one anti arithmics
Phase 0
51
How is slope of phase 4 in myocardial cell action potential increased /slowdown
By blocking K channels
52
What is the effect of slowing down / Increase slope of phase 4 in myocardial cells on repolarisation
Repolarisation is delayed
53
Effect of slowing down/ Increase slope of phase 4 on Action potential duration In myocardial cell action potential
Increased APD action potential duration
54
Effect of slowing down/ Increase slope of phase 4 on QT Interval In myocardial cell action potential
Increases QT interval
55
What is the mechanism of class 1 A of anti arithmetic
Blocking Na and K channels
56
Drugs of Class 1A anti arithmetic
Quinidine
Procainamide
Disopyramide
57
Class of Anti arithmics to be avoided in Hyperkalemia
Class 1
58
Drug induced lupus is caused by
SHIP Drugs
59
SHIP Drugs are
Sulfasalazine or sulpha drugs
Hydralazine
isoniazid
Procinamide
60
Anti arithmetic causing drug induced lupus
procinamide
61
TB drug causing drug induced lupus
Isoniazid
62
SHIP drugs are metabolised by
Acetylation
63
Acetylation occurs in phase 1 or phase 2 of metabolization
Phase two /adding
64
Torsade pointes Is caused by which class of anti-arrhythmics
Class 1A and class 3
65
Q T interval Corresponds to which duration
APD Action potential duration
66
Effect of class 1B anti arrhythmics on phase 4 of myocardial cell action potential
Open potassium channel
Fasten phase 4
Decreases APD decreases QT interval
67
Drugs of class 1 B of anti arithmics
lignocaine
Phenytoin
68
Anti ayurrhythmic of Choice for digitalis induced arrhythmia
lignocaine
69
Drug of choice for digitalis induced arrhythmia
Antidote digibind
Lignocaine
70
Drug of choice for ischemia induced arrhythmia
lignocaine
71
Lignocaine is drug of choice for which arrhythmias ?
mostly in which part of heart?
Digitalis induced arrhythmia
ischemia induced arrhythmia
Mostly ventricular
72
Which class of anti- Arrhythmics is contradicated in ischemia induced arrhythmia
Class 1C
73
Effect of class 1C anti arithmetic on phase 4 of myocardial cell action potential
No effect
74
Class 1C anti arithmics work on which phases in myocardial cell action potential
Only phase 0
blocking sodium channels
75
Drugs in class 1C of anti arithmics
flecainide
Propafenone
76
Beta blockers are in which class of anti arithmetic
Class 2
77
K channel blockers are in which class of anti arithmetic
Class 1A
class 3
78
Effect of class 3 anti-arithmic on phase 0 Of myocardial cell action potential
No effect
79
effect of Class 3 anti arrhythmic on phase 4 Of myocardial cell action potential
Slow down
Longer curved slope
80
Qt interval and action potential are increased in which classes of anti arithmics
Class1 a class 3
81
Which channel blockers Increase action potential duration And QT interval
K channel blockers
82
Drugs in class 3 of anti arithmics
(AIDSdrugs)
amiodarone
Ibutelide
Dofetilide
Sotalol
83
Anti Arhythmics to be avoided in hypokalemia
Class 3
84
85
CCB Calcium channel blockers are which class of anti arithmics
Class 4
86
Class 5 anti arithmetic
Adenosine
87
Drug with action of all four classes of anti arithmetic
Amiodarone
88
Mnemonic
please
check
PFT
LFT
TFT for
Side effect of amiodarone
Photosensitivity /pigmentation( blue/ceruloderma)
Corneal deposits
Pulmonary fibrosis
Hepatotoxic
Hypo /Hyperthyroid
89
Amiodarone causes hypo or hyperthyroidism
both
90
Wolf chaikoff effect is
Hypothyroidism
91
Jod Basdow effect is
Hyperthyroidism
92
Adenosine is Used mainly in
P S V T
93
adenosine causes what in AV node
94
First thing to do in stable psvt patient
carotid sinus massage
Vagal manoeuvre
95
96
Stable psvt first drug
Half life
Route
Adenosine
10sec(very short)
Iv bolus
97
Unstable psvt management
Cardioversion
98
Dose of adenosine in psvt
Max dose
6mg _ 12mg _ 12 mg
30 mg
99
Theophylline causes diuresis by
Blocking adenosine
100
Caffine causes diuresis by
Blocking adenosine receptors
101
Adenosine dose in Caffine ted patient tube increased or decreased
Increased as caffine/theophylline blocks adenosine
12 mg
102
First to see in ECG
Heart rate
103
second to be checked in ecg after heart rate
1 P waves
2 extra waves
104
third to check in ecg
bradyarrythmias=heart block
tachyarrythmias
105
order to remember in ecg
1 heart rate
2 p waves
3 extra waves
4 bradyarrythmia=heartblock /tachyarrythmia
106
big box of ecg is how many seconds
0.2 sec
107
big box of ecg length
5 mm
108
one big box is how many mV for amplitude
0.5mV
109
low amplitude ecg is?
when R wave is not reaching 1mV / 2 big boxes
110
atrial depolarization causes which wave
P wave
111
ventricular depolarization causes which wave
QRS
112
isoelectric point?
present where
J point
where S waves meets baseline ( after S point)
113
ST elevation or depression is seen at which pint
after J point
baseline after S
114
ventricular repolarization causes which wave
T wave
115
normal extra wave may or may not be present?
where?
U wave
after T wave
116
PR interval from to
from beginning of P wave to beginning of QRS
117
normal PR interval
0.1to 0.2 secs
120 to 200 msec
118
normal QRS interval
100 msec
119
tachyarrhythmias can be decided by
narrow QRS/ wide QRS
120
QT interval from to
beginning of QRS till END of T wave
121
bazette's interval gives what
QTc
122
QTc formula
QT/root of(RR)
123
prolonged QT is
more than 440 msec
can be diff in males and females
124
U wave is seen in
hypokalemia
125
how to calculate HR on ECG
1) 300/ no. of big boxes between RR interval
2) more than 5 boxes=bradycardia
less than 3 boxes = tachycardia
126
normal range of HR on ECG
60 - 100 b/sec
127
shape of P pulmonale on ECG
tall P wave
128
tall P (P pulmonale) wave is seen on ECG in?
RAH
right atrial hypertrophy
129
shape of P mitrale on ECG
bifid P wave
130
bifid P wave (P mitrale) on ECG is seen in?
LAH
left atrial hypertrophy
131
Himalayan P waves shape on ECG
very very tall P wave
132
Himalayan P waves seen on ECG in?
when atria has become big
atrialization of ventricle
box shaped heart
EBSTIEN ANOMALY
133
pseudo P pulmonale is on ECG is seen in?
hypokalemia
134
3 accessory waves
delta
osborn
epsilon
135
PR interval decreased means
conduction from atria to ventricle has become very fast
136
Decreased PR interval
Slurring seen
which extra wave?
later what happens to QRS?
which disease?
total interval ?
Delta wave
QRS increases
seen with accessory Bundle of Kent in wolff Parkinson's white disease
total interval increases
137
delta wave seen in
WPW syndrome
138
accessory bundle of Kent seen in
WPW syndrome
139
what does bundle of Kent do in WPW syndrome
provoides fast conduction from A to V = decreases PR interval
but increases overall duration = increases QRS
140
drugs to be avoided in WPW
av node blockers
(adenisine
beta blockers
ccb-verapamil)
141
AV node blockers?
1 adenosine
2 beta blockers
3 ccb-verapamil
142
drug of choice for WPW syndrome
flecainide
143
treatment of choice for WPW syndrome
RFA
(radio frequency ablation)
ablate Bundle of Kent
144
emergency treatment in WPW syndrome
IV procainamide
145
which anti arrythmics classes used in wpw
class 1A and 1C
146
extra waves at J pint
osborn
epsilon
147
hypothermia shows what on ECG
osborn wave at J point
148
osborn wave is seen on ECG in?
hypothermia
149
what is seen on ECG in arrhythmogenic right ventricular dysplasia
epsilon wave at J point
150
epsilon wave is seen in
ARVD
151
congenital condition in which RV muscle is replaced by fatty fibrous tissue that can cause sudden cardiac death
ARVD
arrhythmogenic rt ventricular dysplasia
152
TOC of any structural cause sudden cardiac arrest
1 implantable cardiac defibrillator
2 beta blocker
(ICD + beta blocker)
153
TOC for non structural cause or sudden cardiac arrest
like brugada syndrome
only ICD
(implantable cardiac defibrillator)
154
pathology of ARVD
RV muscle replaced by fatty/ fibrous tissue in ARVD
155
RV muscle replaced by fatty/ fibrous tissue in?
Arrhythmogenic right ventricular dystrophy
156
wooly hair
palmoplanter keratoderma
arvd seen in
Naxos syndrome
157
leads for axis deviation
waves to be seen
1 aVF
tallest
158
leads 1 amd aVF both positive
normal axis
159
if lead 1 positive and lead aVF negative
leaving each other
Left axis deviation
160
if lead 1 negative and lead aVF positive
reaching towards each other
Right axis deviation
161
both lead 1 and aVF negative
extreme axis deviation
162
leads to be seen for bundle branch block
V1 and V6
163
if R and R' waves seen on V1
'M' shaped
in RBBB
164
if 'w' seen in V6
RBBB
165
IF 'w' is seen in V1
LBBB
166
if 'M' is seen in V6
LBBB
167
'william' for
LBBB
168
'marrow' for
RBBB
169
first to see in RBBB and LBBB on ECG
LBBB
170
Sokolow lyon criteria for
LVH
171
V1 S wave becomes very deep in
V6 R wave is very Tall
LVH
172
what is Sokolow lyon criteria
V1 S wave deapth + V6 R wave height is more than (7 large boxes) more than 35mm / 3.5 mV
shows LVH
173
V1 R wave is more than 7 mm in?
RVH
174
PR prolongation but constant in what heart failure
1 degree
175
wenkeback's phenomenon AKA
(2 degree)Mobitz type 1
176
what happens to PR interval in Mobitz type1 HB
INCREASES gradually until a skipped beat where P wave is not followed by QRS
177
PR interval INCREASES gradually until a skipped beat where P wave is not followed by QRS in?
(2 degree) Mobitz type 1
178
sudden skipped beat in normal PR interval seen in
(2 degree) Mobitz type 2
179
what happens in (2 degree ) Mobitz type 2
normal PR but suddenly nor QRS after P wave
sudden skipping of QRS
180
3 degree HB seen in
AV dissociation
181
what happens in 3 degree HB
PP interval and RR interval are normal and constant but not related to each other
182
PP interval and RR interval are normal and constant but not related to each other in?
3 degree HB
183
complete HB is?
3 degree HB
184
atrium and ventricle are contracting on there own respectively in which HB
3 degree HB
185
irregular HR on ECG with constant PQRS in elderly seen in
Sick sinus syndrome
186
sick sinus syndrome
aged sinus beats when is wants(irregularly)
but PQRS is constant
187
when to treat HB
only in unstable/symptomatic
not to treat stable/ asymptomatic
188
first line drug for HB
atropine 0.5mg iv bolus
189
management for HB (unstable/symptomatic only)
atropine 0.5 mg iv bolus(1st line)
dopamine iv infusion
epinephrine iv infusion
190
how to diff supraventricular or ventricular tachyarrhythmias
