ECG and arrhythmias

Question 1

MC tachycardia caused by an accessory pathway

Answer 1

PSVT orthodromic AV reentry

Question 2

PVCs origin

• with smooth uninterrupted contour
• sharp QRS deflections

Answer 2

ectopic focus in Normal myocardium

Question 3

PVCs origin

• broad notching
• sharp QRD deflections

Answer 3

diseased myocardial substrate

Question 4

MC site of origin for idiopathic ventricular arrhythmias

Answer 4

RV outflow tract

Question 5

very rapid monomorphic VT that has a sinusoidal appearance

Answer 5

ventricular flutter

Question 6

3 or more consecutive beats at rate faster than 100 bpm

Answer 6

Vtach

Question 7

Tach that has same QRS complex from beat to beat

Answer 7

monomorphic VTach

Question 8

VTach prominent S wave v1

LBBB config

Answer 8

from RV or septum

Question 9

If duration of AF is 48 h or unknown

To answer concern about thromboembolism

Answer 9

Anticoagulate for 3 weeks before

4 weeks after cardioversion

Question 10

Goal of rate control in AF

Answer 10

resting HR of less than 80 bpm
and increases to less than 100 bpm on exercise
(resting rate of 110 bpm ok if no symptoms)

Question 11

common post MI are PVCs and NSVT

how to treat

Answer 11

correct electrolytes

beta blockers

Question 12

Depression of ventricular function rarely occurs unless PVCs account of more than _____ over 24h period

Answer 12

10-20% of total beats

Question 13

3 or more ventricular beats bpm less than 100

Answer 13

idioventricular rhythm

Question 14

likely mechanism for idioventricular rhythm

cure if with hemodynamic compromise

Answer 14

automaticity

atropine

Question 15

rare syndrome characterised by >0.2 mV ST segment elevation with a coved ST segment and negative T wave in more than 1 anterior precordial lead

Answer 15

brugada syndrome

Question 16

qtc of short qt syndrome (gain of function of IKr)

Answer 16

less than 0.36

Question 17

LQTS sudden death during sleep

Answer 17

LQTS3

Question 18

LQTS syncope or cardiac arrest during exertion

Answer 18

LQTS1

Question 19

LQTS syncope or cardiac arrest during sudden auditory stimuli or emotional upset

Answer 19

LQTS2

Question 20

channel involved in Brugada syndrome

Answer 20

sodium channels

Question 21

FXa inhibitor anticoag stroke prevention in atrial fibrillation

Answer 21

rivarixaban

apixaban

Question 22

stroke prevention in atrial fibrillation

mech of dabigatran

Answer 22

thrombin inhibitor

Question 23

reversal agent for dabigatran

Answer 23

ivarisuzumab

Question 24

Rx PSVT if no termination after
1 Vagal maneuvers
2 IV adenosine
3 IV verapamin/diltiazem

Answer 24

IV ibutilide+ AV nodal blocking agent
IV procainamide + AV nodal blocking agent
cardioversion

Question 25

anticoag stroke prevention in atrial fibrillation eliminated by kidney and liver

Answer 25

apixaban

Question 26

Most common form of Paroxysmal SVT (PSVT )

Answer 26

AV nodal reentry tachycardia

Question 27

Mechanism is reentry involving the AV node and the perinodal atrium made possible by the existence of multiple pathways for conduction from the atrium to the AV node

Answer 27

AV nodal reentry tachycardia

Question 28

P wave is slight light inscribed before or after QRS complex pseudo r or pseudo s

Answer 28

AVNRt

Question 29

Favors Atrial tachycardia

rather than AV nodal dependent SVT

Answer 29

1) Atrial tachycardia will not terminate with an AV block (cos it is not dependent on AV nodal conduction)
2) Accelerated warm up phase after initiation and cool down phase prior to termination

Question 30

What are the chances that a patient with atrial flutter will develop atrial fibrillation in the next 5 years

Answer 30

50%

Question 31

Anticoagulant eliminated through kidney so use cautiously

Answer 31

Dabigatran, Rivaroxaban, Apixaban

Question 32

Most common sustained arrhythmia

Answer 32

Atrial fibrillation

Question 33

Duration of persistent AF

Answer 33

more than 7 days

Question 34

Management new onset AF withs severe hypotension, pulmonary oedemaa and angina

Answer 34

Cardioversion 200J

Question 35

Cardioversion in AF exceeding 48h or unknown duration

Answer 35

1) anticoagulate continuously for 3 weeks before and a minimum of 4 weeks after cardioversion
2) start anticoagulation and perform a transesophageal 2d echo to determine if a thrombus is present in the left atrial appendage

Question 36

When do you start anticoagulation in patients with atrial fibrillation?

Answer 36

1) more than 48h AF and are undergoing cardioversion
2) patients with prior history of stroke
3) CHADSVasc sore 2 and up

Question 37

% reduction of warfarin annual risk of stroke

Answer 37

64% compared to placebo

35% compared to anti platelet therapy

Question 38

when is ICD recommended for survivors of acute MI

Answer 38

EF <0.3
EF <0.35 and symptmatic HF Class II or III
nonsustained VT

Question 39

Use in patients with structural heart disease INSTEAD of Class I Na blocking agents

Answer 39

Sotalol

Dofetilide

Question 40

3 or more frequent beats at a rate slowedr than 100 beats per min

Answer 40

idioventricular rhythm

Question 41

epsilon wave

Answer 41

ARVC

Question 42

scars on cardiac MRI

Answer 42

areas of delayed gadolinium enhancement

Question 43

sustained VT with a RBBB configuration.

manage

Answer 43

LV intrafascicular VT

give Verapamil.

Question 44

First line therapy for idiopathic VT

Answer 44

Beta blockers

others Non DHP CCB