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Cvs Flashcards

1
Q

Plateu phase is seen in Pacemakers or myocardial cells

A

Myocardial cells

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2
Q

Effective refractory period In action potential of myocardial cell

A

200msec

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3
Q

Effective refractory period In nerve fibre cell is

A

2 to 4 msec

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4
Q

Nerve can be tatanized while myocardial cell cannot be tetanised because of difference in what

A

Effective Refractory period

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5
Q

RMP of Myocardial Cell is

A

-85 mV

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6
Q

Depolarisation in myocardial cells is due to

A

Influx of Na

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7
Q

Phase 0 in myocardial cell Action potential is due to

A

Influx of Na

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8
Q

Which phases are completely above 0 mV in myocardial cell action potential

A

Phase 1 and phase 2

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9
Q

Phase 1 in myocardial action potential is due to

A

Potassium efflux

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10
Q

Which phase is transient repolarisation In Myocardial Cell action potential

A

Phase 1

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11
Q

Potassium moves out of myocardial cell in which phases

A

Phase 1phase 2 phase 3

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12
Q

In phase 2 which iron in flux occurs in myocardial action potential

A

Calcium influx

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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

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14
Q

Two ions neutralise each other in myocardial action potential in which phase ?
Which two ions?

A

In phase two
Calcium and potassium

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15
Q

Which ion involved in phase three of myocardial action potential

A

Potassium efflux

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16
Q

Phase 4 of myocardial action potential is dominated by which ion

A

Potassium

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17
Q

Which is resting phase in myocardial action potential

A

Phase 4

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18
Q

Most important feature in pacemaker action potential is

A

It has to do automatic depolarisation

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19
Q

Phase four is not resting in which action potential myocardial or pacemaker

A

Pacemaker action potential has non resting phase 4

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20
Q

Funny current are seen in which phase of which action potential

A

Phase four of pacemaker action potential

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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

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22
Q

If( Na and K ) MIXED Channels are activated by?

A

Hyperpolarization and cAMP

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23
Q

If( Na and K ) Are type of which channels

A

HCN 4
Hyperpolarization activated cyclic nucleotide channels

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24
Q

If( Na and K ) Are fast or slow channels

A

slow

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25
Q

What are structures with least speed of conduction and why

A

Nodes
SA node and AVN
Because of slow channels If( Na and K )

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26
Q

Cardiac structures As per Speed of conduction in decreasing order

A

His perkinje bundle
Atria
Ventricles
AVN

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27
Q

Fastest speed of conduction in Cardiac pacemaker cells is

A

HIS purkinje fibres

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28
Q

Mnemonic ‘Park at ventura avenue’for

A

speed of Conduction in cardiac Pacemakers cells

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29
Q

Pneumonic for phase 4 channel in pacemaker action potential

A

Funny CAT

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30
Q

Type of Calcium channel in phase 0 Of pacemaker action potential

A

L type
SLOW type

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31
Q

Phase 4 of pacemaker action potential Till what membrane potentials

A

-40mV

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32
Q

which iron channels dominate phase three of pacemaker action potential

A

Potassium

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33
Q

Which ion channels dominate phase one of pacemaker action potential

A

Calcium L type

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34
Q

How many faces and what number in pacemaker action potential

A

Three phases
phase 4 phase 0 phase 3

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35
Q

How does Acetylcholine act on Pacemaker cell action potential

A

Slow down phase 4
Decrease rate of conduction at AV node

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36
Q

How does Adenosine act on pacemaker action potential

A

Slow down phase 4
Decreases rate of conduction at AV node

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37
Q

How does Catecholamines act on pacemaker action potential

A

Fasten phase 4
Increase rate of conduction at AV node

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38
Q

How does Cakcium Channel blockers act on pacemaker action potential

A

Slow down phase 4
It decreases Rate of conduction in AV node

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39
Q

How does Beta blocker act on pacemaker action potential

A

Slow down phase 4
It decreases Rate of conduction in AV node

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40
Q

How does Parasympathetic systemact on pacemaker action potential

A

Slow down phase 4
It decreases Rate of conduction in AV node

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41
Q

What type of calcium channel blockers a slowdown pacemaker action potential phase 0

A

Non DHP
Verapamil
Diltiazim

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42
Q

WPW bypasses which structure

A

AV Node

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43
Q

What happened to WPW bundle when conduction of AV node is decreased

A

More current will pass through WPW Bundle

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44
Q

Which drugs are contraindicated in WPW syndrome

A

All drugs that decreases rate of conduction in AV node
Acetylcholine
adenosine
beta blockers
calcium channel blockers parasympathomimetic?

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45
Q

Drugs that decrease rate of conduction of AV node are DOC in which condition
Acetylcholine adenosine beta blockers calcium channel blockers parasympathomimetics?

A

PSVT

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46
Q

AV Node re entrant circuit is seen in
AVRT

A

PSVT

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47
Q

Which drugs are helpful in AVRT

A

Acetylcholine
Adenosine
beta blockers
calcium channel blockers parasympathomatics

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48
Q

Von/ won classification for which drugs

A

Anti Arhythmics

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49
Q

Which channels are blocked in class one anti arrythmics

A

Sodium channels are blocked

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50
Q

Which slope goes down in all class one anti arithmics

A

Phase 0

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51
Q

How is slope of phase 4 in myocardial cell action potential increased /slowdown

A

By blocking K channels

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52
Q

What is the effect of slowing down / Increase slope of phase 4 in myocardial cells on repolarisation

A

Repolarisation is delayed

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53
Q

Effect of slowing down/ Increase slope of phase 4 on Action potential duration In myocardial cell action potential

A

Increased APD action potential duration

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54
Q

Effect of slowing down/ Increase slope of phase 4 on QT Interval In myocardial cell action potential

A

Increases QT interval

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55
Q

What is the mechanism of class 1 A of anti arithmetic

A

Blocking Na and K channels

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56
Q

Drugs of Class 1A anti arithmetic

A

Quinidine
Procainamide
Disopyramide

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57
Q

Class of Anti arithmics to be avoided in Hyperkalemia

A

Class 1

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58
Q

Drug induced lupus is caused by

A

SHIP Drugs

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59
Q

SHIP Drugs are

A

Sulfasalazine or sulpha drugs
Hydralazine
isoniazid
Procinamide

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60
Q

Anti arithmetic causing drug induced lupus

A

procinamide

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61
Q

TB drug causing drug induced lupus

A

Isoniazid

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62
Q

SHIP drugs are metabolised by

A

Acetylation

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63
Q

Acetylation occurs in phase 1 or phase 2 of metabolization

A

Phase two /adding

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64
Q

Torsade pointes Is caused by which class of anti-arrhythmics

A

Class 1A and class 3

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65
Q

Q T interval Corresponds to which duration

A

APD Action potential duration

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66
Q

Effect of class 1B anti arrhythmics on phase 4 of myocardial cell action potential

A

Open potassium channel
Fasten phase 4
Decreases APD decreases QT interval

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67
Q

Drugs of class 1 B of anti arithmics

A

lignocaine
Phenytoin

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68
Q

Anti ayurrhythmic of Choice for digitalis induced arrhythmia

A

lignocaine

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69
Q

Drug of choice for digitalis induced arrhythmia

A

Antidote digibind
Lignocaine

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70
Q

Drug of choice for ischemia induced arrhythmia

A

lignocaine

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71
Q

Lignocaine is drug of choice for which arrhythmias ?
mostly in which part of heart?

A

Digitalis induced arrhythmia
ischemia induced arrhythmia
Mostly ventricular

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72
Q

Which class of anti- Arrhythmics is contradicated in ischemia induced arrhythmia

A

Class 1C

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73
Q

Effect of class 1C anti arithmetic on phase 4 of myocardial cell action potential

A

No effect

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74
Q

Class 1C anti arithmics work on which phases in myocardial cell action potential

A

Only phase 0
blocking sodium channels

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75
Q

Drugs in class 1C of anti arithmics

A

flecainide
Propafenone

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76
Q

Beta blockers are in which class of anti arithmetic

A

Class 2

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77
Q

K channel blockers are in which class of anti arithmetic

A

Class 1A
class 3

78
Q

Effect of class 3 anti-arithmic on phase 0 Of myocardial cell action potential

A

No effect

79
Q

effect of Class 3 anti arrhythmic on phase 4 Of myocardial cell action potential

A

Slow down
Longer curved slope

80
Q

Qt interval and action potential are increased in which classes of anti arithmics

A

Class1 a class 3

81
Q

Which channel blockers Increase action potential duration And QT interval

A

K channel blockers

82
Q

Drugs in class 3 of anti arithmics

A

(AIDSdrugs)
amiodarone
Ibutelide
Dofetilide
Sotalol

83
Q

Anti Arhythmics to be avoided in hypokalemia

A

Class 3

84
Q
A
85
Q

CCB Calcium channel blockers are which class of anti arithmics

A

Class 4

86
Q

Class 5 anti arithmetic

A

Adenosine

87
Q

Drug with action of all four classes of anti arithmetic

A

Amiodarone

88
Q

Mnemonic
please
check
PFT
LFT
TFT for

A

Side effect of amiodarone
Photosensitivity /pigmentation( blue/ceruloderma)

Corneal deposits

Pulmonary fibrosis

Hepatotoxic

Hypo /Hyperthyroid

89
Q

Amiodarone causes hypo or hyperthyroidism

A

both

90
Q

Wolf chaikoff effect is

A

Hypothyroidism

91
Q

Jod Basdow effect is

A

Hyperthyroidism

92
Q

Adenosine is Used mainly in

A

P S V T

93
Q

adenosine causes what in AV node

A
94
Q

First thing to do in stable psvt patient

A

carotid sinus massage
Vagal manoeuvre

95
Q
A
96
Q

Stable psvt first drug
Half life
Route

A

Adenosine
10sec(very short)
Iv bolus

97
Q

Unstable psvt management

A

Cardioversion

98
Q

Dose of adenosine in psvt
Max dose

A

6mg _ 12mg _ 12 mg
30 mg

99
Q

Theophylline causes diuresis by

A

Blocking adenosine

100
Q

Caffine causes diuresis by

A

Blocking adenosine receptors

101
Q

Adenosine dose in Caffine ted patient tube increased or decreased

A

Increased as caffine/theophylline blocks adenosine
12 mg

102
Q

First to see in ECG

A

Heart rate

103
Q

second to be checked in ecg after heart rate

A

1 P waves
2 extra waves

104
Q

third to check in ecg

A

bradyarrythmias=heart block
tachyarrythmias

105
Q

order to remember in ecg

A

1 heart rate
2 p waves
3 extra waves
4 bradyarrythmia=heartblock /tachyarrythmia

106
Q

big box of ecg is how many seconds

A

0.2 sec

107
Q

big box of ecg length

A

5 mm

108
Q

one big box is how many mV for amplitude

A

0.5mV

109
Q

low amplitude ecg is?

A

when R wave is not reaching 1mV / 2 big boxes

110
Q

atrial depolarization causes which wave

A

P wave

111
Q

ventricular depolarization causes which wave

A

QRS

112
Q

isoelectric point?
present where

A

J point
where S waves meets baseline ( after S point)

113
Q

ST elevation or depression is seen at which pint

A

after J point
baseline after S

114
Q

ventricular repolarization causes which wave

A

T wave

115
Q

normal extra wave may or may not be present?
where?

A

U wave
after T wave

116
Q

PR interval from to

A

from beginning of P wave to beginning of QRS

117
Q

normal PR interval

A

0.1to 0.2 secs
120 to 200 msec

118
Q

normal QRS interval

A

100 msec

119
Q

tachyarrhythmias can be decided by

A

narrow QRS/ wide QRS

120
Q

QT interval from to

A

beginning of QRS till END of T wave

121
Q

bazette’s interval gives what

A

QTc

122
Q

QTc formula

A

QT/root of(RR)

123
Q

prolonged QT is

A

more than 440 msec
can be diff in males and females

124
Q

U wave is seen in

A

hypokalemia

125
Q

how to calculate HR on ECG

A

1) 300/ no. of big boxes between RR interval
2) more than 5 boxes=bradycardia
less than 3 boxes = tachycardia

126
Q

normal range of HR on ECG

A

60 - 100 b/sec

127
Q

shape of P pulmonale on ECG

A

tall P wave

128
Q

tall P (P pulmonale) wave is seen on ECG in?

A

RAH
right atrial hypertrophy

129
Q

shape of P mitrale on ECG

A

bifid P wave

130
Q

bifid P wave (P mitrale) on ECG is seen in?

A

LAH
left atrial hypertrophy

131
Q

Himalayan P waves shape on ECG

A

very very tall P wave

132
Q

Himalayan P waves seen on ECG in?

A

when atria has become big
atrialization of ventricle
box shaped heart
EBSTIEN ANOMALY

133
Q

pseudo P pulmonale is on ECG is seen in?

A

hypokalemia

134
Q

3 accessory waves

A

delta
osborn
epsilon

135
Q

PR interval decreased means

A

conduction from atria to ventricle has become very fast

136
Q

Decreased PR interval
Slurring seen
which extra wave?
later what happens to QRS?
which disease?
total interval ?

A

Delta wave
QRS increases
seen with accessory Bundle of Kent in wolff Parkinson’s white disease
total interval increases

137
Q

delta wave seen in

A

WPW syndrome

138
Q

accessory bundle of Kent seen in

A

WPW syndrome

139
Q

what does bundle of Kent do in WPW syndrome

A

provoides fast conduction from A to V = decreases PR interval
but increases overall duration = increases QRS

140
Q

drugs to be avoided in WPW

A

av node blockers
(adenisine
beta blockers
ccb-verapamil)

141
Q

AV node blockers?

A

1 adenosine
2 beta blockers
3 ccb-verapamil

142
Q

drug of choice for WPW syndrome

A

flecainide

143
Q

treatment of choice for WPW syndrome

A

RFA
(radio frequency ablation)
ablate Bundle of Kent

144
Q

emergency treatment in WPW syndrome

A

IV procainamide

145
Q

which anti arrythmics classes used in wpw

A

class 1A and 1C

146
Q

extra waves at J pint

A

osborn
epsilon

147
Q

hypothermia shows what on ECG

A

osborn wave at J point

148
Q

osborn wave is seen on ECG in?

A

hypothermia

149
Q

what is seen on ECG in arrhythmogenic right ventricular dysplasia

A

epsilon wave at J point

150
Q

epsilon wave is seen in

A

ARVD

151
Q

congenital condition in which RV muscle is replaced by fatty fibrous tissue that can cause sudden cardiac death

A

ARVD
arrhythmogenic rt ventricular dysplasia

152
Q

TOC of any structural cause sudden cardiac arrest

A

1 implantable cardiac defibrillator
2 beta blocker
(ICD + beta blocker)

153
Q

TOC for non structural cause or sudden cardiac arrest
like brugada syndrome

A

only ICD
(implantable cardiac defibrillator)

154
Q

pathology of ARVD

A

RV muscle replaced by fatty/ fibrous tissue in ARVD

155
Q

RV muscle replaced by fatty/ fibrous tissue in?

A

Arrhythmogenic right ventricular dystrophy

156
Q

wooly hair
palmoplanter keratoderma
arvd seen in

A

Naxos syndrome

157
Q

leads for axis deviation
waves to be seen

A

1 aVF
tallest

158
Q

leads 1 amd aVF both positive

A

normal axis

159
Q

if lead 1 positive and lead aVF negative

A

leaving each other
Left axis deviation

160
Q

if lead 1 negative and lead aVF positive

A

reaching towards each other
Right axis deviation

161
Q

both lead 1 and aVF negative

A

extreme axis deviation

162
Q

leads to be seen for bundle branch block

A

V1 and V6

163
Q

if R and R’ waves seen on V1

A

‘M’ shaped
in RBBB

164
Q

if ‘w’ seen in V6

A

RBBB

165
Q

IF ‘w’ is seen in V1

A

LBBB

166
Q

if ‘M’ is seen in V6

A

LBBB

167
Q

‘william’ for

A

LBBB

168
Q

‘marrow’ for

A

RBBB

169
Q

first to see in RBBB and LBBB on ECG

A

LBBB

170
Q

Sokolow lyon criteria for

A

LVH

171
Q

V1 S wave becomes very deep in
V6 R wave is very Tall

A

LVH

172
Q

what is Sokolow lyon criteria

A

V1 S wave deapth + V6 R wave height is more than (7 large boxes) more than 35mm / 3.5 mV
shows LVH

173
Q

V1 R wave is more than 7 mm in?

A

RVH

174
Q

PR prolongation but constant in what heart failure

A

1 degree

175
Q

wenkeback’s phenomenon AKA

A

(2 degree)Mobitz type 1

176
Q

what happens to PR interval in Mobitz type1 HB

A

INCREASES gradually until a skipped beat where P wave is not followed by QRS

177
Q

PR interval INCREASES gradually until a skipped beat where P wave is not followed by QRS in?

A

(2 degree) Mobitz type 1

178
Q

sudden skipped beat in normal PR interval seen in

A

(2 degree) Mobitz type 2

179
Q

what happens in (2 degree ) Mobitz type 2

A

normal PR but suddenly nor QRS after P wave
sudden skipping of QRS

180
Q

3 degree HB seen in

A

AV dissociation

181
Q

what happens in 3 degree HB

A

PP interval and RR interval are normal and constant but not related to each other

182
Q

PP interval and RR interval are normal and constant but not related to each other in?

A

3 degree HB

183
Q

complete HB is?

A

3 degree HB

184
Q

atrium and ventricle are contracting on there own respectively in which HB

A

3 degree HB

185
Q

irregular HR on ECG with constant PQRS in elderly seen in

A

Sick sinus syndrome

186
Q

sick sinus syndrome

A

aged sinus beats when is wants(irregularly)
but PQRS is constant

187
Q

when to treat HB

A

only in unstable/symptomatic
not to treat stable/ asymptomatic

188
Q

first line drug for HB

A

atropine 0.5mg iv bolus

189
Q

management for HB (unstable/symptomatic only)

A

atropine 0.5 mg iv bolus(1st line)
dopamine iv infusion
epinephrine iv infusion

190
Q

how to diff supraventricular or ventricular tachyarrhythmias

A

AM (12 decks)

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