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EP Flashcards

1
Q

WPW without symptoms risk stratification

A

Exercise stress test

Procainamide challenge

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2
Q

Long RP interval regular, narrow complex tachycardia

A

Sinus tachycardia

Atrial tachycardia

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3
Q

Short RP narrow complex tachycardia

A

AVNRT

Accessory pathway

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4
Q

Typical atrial flutter EKG

A

Negative II, III, aVF

Positive V1

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5
Q

Does reduction dabigatran CKD

A

CrCl 15-30, reduce to 75 mg BID

Not recommended CrCl < 15

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6
Q

Does reduction rivaroxaban CKD

A

CrCl 15-30, reduce to 15 mg daily

Not recommended CrCl < 15

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7
Q

Does reduction apixaban CKD

A

2.5 mg BID if 2/3 factors present

CrCl < 15 / HD, 5 mg BID (2.5 mg BID if age >= 80 or weight <= 60)

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8
Q

Does reduction edoxaban CKD

A

CrCl 15-30, reduce to 30 mg daily

Not recommended CrCl < 15

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9
Q

AF AAD if no structural heart disease

A 
Flecainide
Propafenone
Sotalol
Dronaderone
Dofetilide
Amiodarone second line
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10
Q

AF AAD if CAD, MI hx

A

Sotalol
Dofetilide
Dronedarone
Amiodarone second line

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11
Q

AF AAD if LV dysfunction

A

Dofetilide

Amiodarone

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12
Q

Acute AF ablation complications

A

Tamponade
Phrenic nerve palsy
Volume overload
Recurrent arrhythmia

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13
Q

Subacute / Delayed AF ablation complications

A

PV stenosis
Recurrent arrhythmia
Stiff LA syndrome

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14
Q

AF ablation atrial esophageal fistula features

A 
1-4 weeks after
Fever, chills
Esophageal symptoms
Stroke
GIB
Dx - CT chest contrast
Tx - surgery
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15
Q

WCT LBBB morphology

A

Terminal QRS negative V1

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16
Q

WCT RBBB morphology

A

Terminal QRS positive V1

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17
Q

Features of VT vs SVT with aberrancy

A 
AV dissociation
Capture beats
Fusion beats
Right superior axis
Precordial concordance
Abnormal septal activation
Slow initial slope, fast terminal slope
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18
Q

Idiopathic VT types

A

Outflow tract, papillary muscle, perivenous areas

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19
Q

RVOT VT EKG

A

LBBB

Inferior axis

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20
Q

Outflow tract tachycardia features

A

Normal structural heart
Rare sudden death
Exercise, hormonal triggers
Suppressed by AVN blockers

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21
Q

Fascicular tachycardia EKG

A

RBBB + left axis / LAFB

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22
Q

Fascicular tachycardia features

A

Young patient, relatively narrow QRS
Reenetry
Verapamil works, adenosine doesn’t

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23
Q

AADs for scar based VT

A

Class III

Amiodarone, sotalol, dofetilide

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24
Q

ARVC EKG

A

LBBB morphology
TWI V1-V3
Epsiolon wave

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25
Q

Bundle branch reentry arrhythmia features

A

NICM / DCM
Reenetry
VT may look like sinus rhythm
Ablation, ICD

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26
Q

Brugada type I EKG pattern

A

Coved STE in at least one of V1-V3

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27
Q

Brugada Syndrome

A 
Type 1 EKG
Type 2 or 3 if they convert to Type 1
Syncope
Sudden death
Present in >= 1 relative
\+ Genetic test
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28
Q

Genetic test for Brugada Syndrome

A

BrS1

Loss of function in sodium channels

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29
Q

Indications for ICD in Brugada

A

Aborted cardiac arrest
Syncope + spontaneous EKG
?asymptomatic / positive EP study

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30
Q

Medication for Brugada

A

Quinidine

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31
Q

Triggers for Brugada

A

Meds
Alcohol, marijuana, cocaine
Fever

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32
Q

Catecholinorgic Polymorphic Ventricular Tachycardia (CPVT) EKG

A

Normal rest EKG
Bidirectional VT -> VF with exercise
Similar to digoxin toxicity

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33
Q

Features of CPVT

A

Exertion induced syncope / SCD
No structural heart defect
Mimics long QT
Normal rest EKG

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34
Q

Pathophysiology of CPVT

A

RyR2 gene, ryanidine receptor

Leaky calcium channels, diastolic Ca overload, arrhythmias

35
Q

Treatment of CPVT

A

Nadolol + flecainide
Left cardiac sympathetic denervation
Possibly ICD for aborted cardiac arrest

36
Q

Features of congenital long QT syndrome

A

Syncope
Seizures
SCD
Suspicion with exertional, auditory, postpartum syncope / seizures

37
Q

Where to measure QT interval

A

Lead II and V5, not V2/V3

Measure from where downward slope of t hits baseline

38
Q

QT less than half RR interval =

39
Q

Measuring QT interval in sinus arrhythmia or AF

A

Take average of QT and RR intervals

40
Q

Wide QRS adjustment for QTc

A

Adjusted QTc = QTc - [QRS - 120]

41
Q

Guidelines for abnormal QTc

A

450 men

460 women

42
Q

Risk rises with QTc of

43
Q

Congenital long QT path

A

Defective ion channels
17 genes
LQT1, LQT2, LQT3 make up majority

44
Q

LQT1

A

Loss of function in potassium channel
Broad based T wave
Adrenergic trigger - swimming
Tx - BB

45
Q

LQT2

A

Loss of function in potassium channel
Notched T
Auditory, postpartum trigger
Tx - BB

46
Q

LQT3

A

Loss of function in sodium channel
Normal T after long isoelectric segment
Arousal, non-adrenergic trigger
Tx - BB

47
Q

LQTS treatment

A

BB - nadolol or propranolol
Denervation therapy
ICD
Avoid meds

48
Q

ICD indications for LQTS

A

Aborted cardiac arrest
LQT2 women with QTc > 500
QTC > 550 and not LQT1

49
Q

Class I AAD mechanism of action

A

Block sodium channels
Slow conduction
Broaden QRS

50
Q

Class Ia AADs

A 
Quinidine
Procainamide
Disopyramide
Amiodarone
Increase QRS and QT, also block K channels
51
Q

Class Ib AADs

A

Lidocaine
Mexiletine
Drug of choice in ischemic myocardium
Decrease QT, less proarrhythmia

52
Q

Class Ic AADs

A

Flecainide
Propafenone
Increase QRS

53
Q

Class III AADs

A

Dofetilide
Sotalol
Prolong depolarization, QT

54
Q

Mechanisms of AAD proarrhythmia

A

Slow conduction - reentry
Prolong repolarization - EADs
Calcium overload - DADs

55
Q

AADs with proarrhythmia through slowed conduction

A

Class Ic agents - black box warning for scar

Monomprhic VT

56
Q

AADs with proarrhythmia through prolonged repolarization

A

Class III agents
Polymorphic VT / torsades
Pause dependent

57
Q

AADs with proarrhythmia through calcium overload

A

Digoxin / CPVT
Bidirectional VT
Not pause dependent

58
Q

Class Ic AADs use dependence

A 
Use dependent
Greater effect at faster HR
Pill in pocket
Potential for wide complex SVT
QRS widening
59
Q

Class III AADs use dependence

A

Reverse use dependence
Slower HR, more effect
Maintenance of sinus rhythm
QT prolongation

60
Q

Class Ib AADs use dependence

61
Q

Amiodarone use dependence

A

Rate independence

62
Q

Treatment for polymorphic VT from class III AADs

A

Increase HR

63
Q

Propafenone / flecainide toxicity

A

Bradycardia, broad QRS

7% of population slow CYP 2D6 metabolizers

64
Q

Amiodarone warfarin interaction

A

Increases INR

65
Q

Amiodarone digoxin interaction

A

Increased digoxin effect

66
Q

Amiodarone cyclosporine, tacrolimus interaction

A

Increases levels

67
Q

Class Ic drug monitoring

A

Rule out ischemia
Baseline QRS
QRS at 14 days +/- stress test

68
Q

Dofetilide drug monitoring

A

Baseline electrolytes, EKG for QTc < 440
Telemetry and serial EKGs for 5 doses
EKG q3 months

69
Q

Sotalol drug monitoring

A

Baseline electrolytes, EKG for QTc < 450
Telemetry and serial EKGs for 5 doses
Periodic QTc assessment

70
Q

RFs for prosthetic valve thrombosis

A

AF
Previous thromboembolism
Hypercoagulability
EF < 30%

71
Q

Reflex syncope / neural mediated / neurocardiogenic

A

Due to reflex that causes vasodilation / bradycardia
Hypotension + bradycardia
Vasovagal, carotid sinus syndrome

72
Q

Treatment of vasovagal syncope

A

Counter pressure maneuvers
Salt and fluid intake
Midodrine, fludrocrotisone, BB, PPM for recurrent

73
Q

Cardioinhibitory response carotid sinus syndrome

A

3+ sec pause or AV block

PPM, anticholinergics

74
Q

Vasodepressor response carotid sinus syndrome

A

> 50 mm fall in BP

Midodrine, florinef, SSRI

75
Q

PPM 1st letter

A

Chamber paced

76
Q

PPM 2nd letter

A

Chamber sensed

77
Q

PPM 3rd letter

A

Response to sensed event

78
Q

PPM 4th letter

A

R (sensor driven pacing)

79
Q

ICD for ToF

A
  • LV systolic dysfunction
  • NSVT
  • QRS >= 180 ms
  • Extensive RV scarring
  • Inducible sustained VT
80
Q

Scar-mediated VT mechanism

81
Q

VT DADs ->

A

Idiopathic outflow tract VT

82
Q

VT EADs ->

83
Q

VT abnormal automaticity ->

A

Fascicular VT

84
Q

Lamin mutation

A

conduction system disease / AV block, ventricular arrhythmias, cardiomyopathy

Cardiology Boards (11 decks)

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