Dysrhythmias

Question 1

list off drugs from Vaughn Williams Classification

Answer 1

I - sodium channel blockers
Ia - quinidine
Ib - lignocaine
Ic - flecainide

II - beta blockers

III - potassium channel blockers
- amiodarone and sotalol

IV - calcium channel blockers
- verapamil and diltiazem

Question 2

which rate control medication is best for exercise in AF?

Answer 2

beta blockers are best

digoxin is least effective with exercise

Question 3

what percentage of OOHCA survive to leave hospital?

Answer 3

apparently it is 70% survival

Question 4

what are the indications for primary prevention ICD insertion

Answer 4

the two major ones:

1. > 1 month post MI, with EF < 35% on optimal therapy
2. heart failure, NYHA class II, LVEF <35%

and also:

3. Patients with syncope who have structural heart disease and inducible sustained VT or VT going to VF on electrophysiology study
4. Select patients with certain underlying disorders who are deemed to be at high risk for life-threatening VT/VF. This includes
   - Patients with congenital long QT syndrome who have recurrent symptoms, torsades de pointes despite therapy with beta blockers, or other high-risk patients.
   - High-risk patients with hypertrophic cardiomyopathy
   - High-risk patients with Brugada syndrome
   - High-risk patients with arrhythmogenic right ventricular cardiomyopathy

Question 5

what is the underlying principle of CRT?

Answer 5

this relies on the concept of ventricular dysynchrony.

basically an intra-ventricular conduction defect leads to the inter-vent septum being pushed into one of the ventricles during systole.

usually there is a LBBB, and the right ventricle contracts first, prolapses the septum into the left ventricle and this leads to poor output from the heart

Question 6

which type of patient is indicated to have CRT?

Answer 6

NYHA class III- IV symptoms
EF < 35%
QRSd >120ms
(usually LBBB)
sinus rhythm 

class II if QRSd >150

Question 7

how do you determine if someone has a high risk of sudden cardiac death with nsVT, RWMA on echo, EF 38%

Answer 7

the patient should undergo a V-stim study

Question 8

which of the following have an interaction with warfarin?

thyroxine
dietary vege intake
cholestyramine
omeprazole
amiodarone

Answer 8

amiodarone will lead to prolonged PT

Question 9

what common stroke treatment has an interaction with adenosine (and we need to dose reduce)

Answer 9

dipyridamole

Question 10

how do you treat long QT syndrome?

Answer 10

simple beta blocker is important

Question 11

what are the findings of Brugada?

Answer 11

atypical RBBB with ST elevation in V1/V2

Question 12

which of the antibiotics can cause long QT?

amoxy
cefaclor
erythromycin
metronidazole
TMP-SXT

Answer 12

erythromycin

Question 13

what’s the strongest indication for anticoag?

age
htn
dm
lipids
mitral stenosis

Answer 13

mitral stenosis is the greatest

Question 14

indications for icd in secondary prevention

Answer 14

1. Patients with a prior episode of resuscitated VT/VF or sustained hemodynamically unstable VT in whom a completely reversible cause cannot be identified. This includes patients with a variety of underlying heart diseases and those with idiopathic VT/VF and congenital long QT syndrome, but not patients who have VT/VF limited to the first 48 hours after an acute MI
2. Patients with episodes of spontaneous sustained VT in the presence of heart disease (valvular, ischemic, hypertrophic, dilated, or infiltrative cardiomyopathies) and other settings (eg, channelopathies).

Question 15

what does brugada syndrome ECG look like?

Answer 15

classically it is Coved ST segment elevation >2mm in >1 of V1-V3 followed by a negative T wave

there are also type 2 and 3 with a ST elevation (saddle shaped)