HF & Arrythmia exam

Question 1

What are the class 1a antiarrhythmics?

Answer 1

mixed block of Na & K channels —> prolongs QT
-Quinidine, procainamide

Question 2

What are the class 1b antiarrhythmics?

Answer 2

weak Na channel block —> no significant effect on ECG
-Lidocaine, mexiletine, phenytoin

Question 3

What are the class 1c antiarrhythmics?

Answer 3

strong Na channel block —> widens QRS complex
-Flecainide

Question 4

What are the class 3 antiarrythymics?

Answer 4

K+ channel blockers; agents that prolong refractory period and QT interval
-Amiodarone, dronedarone, sotalol, Ibutilide, Dofetilide

Question 5

What are the class 2 antiarrythmics?

Answer 5

Beta adrenergic blockers
-Esmolol (cardioselective), acebutolol (cardioselective), propanolol (nonselective)
-slows pacemaker cells and Ca2 currents; increase PR interval

Question 6

What are the class 4 antiarrythmics?

Answer 6

Ca+2 channel blockers
-Verapamil, Diltiazem
-frequency dependent block of Cav1.2 channels; blockade accumulates in rapidly depolarizing tissue (tachycardia)

Question 7

What phase does the class 1 (Na channel blockers) work in?

Answer 7

-phase 0

Question 8

What phase does the class 2 (Beta-blockers) work in?

Answer 8

-phase 4

Question 9

What phase does the class 3 (K channel blocker) work in?

Answer 9

-phase 3

Question 10

What phase does the class 4 (Ca channel blocker) work in?

Answer 10

-phase 2

Question 11

What drugs increase PR interval?

Answer 11

beta-blockers (Esmolol, acebutolol, propranolol)
Ca Channel blockers (verapamil, diltiazem)

Question 12

What drugs widens QRS complex?

Answer 12

Class 1c drugs (Flecainide, propafenone)

Question 13

What drugs lengthen QT?

Answer 13

Class 1a drugs (Quinidine, procainamide, disopyramide)
Class 3 drugs (amiodarone, dronedarone, sotalol, Ibutlilide)

Question 14

What drugs have no ECG changes?

Answer 14

Class 1b drugs (Lidocaine, Mexiletine)

Question 15

What type of fibrillation has no P waves?

Answer 15

atrial fibrillation
-irregularly irregular rhythm
-abnormal pulmonary vein automaticity & mult. re-entry circuits

Question 16

What is the chads-vasc score?

Answer 16

Congestive heart failure, Hypertension, Age > 75 years (2 pts), Diabetes, Stroke/TIA/TE history (2 pts), Vascular disease, Age 65-74 years, Sex (female)

Question 17

When is Warfarin indicated over DOACs for afib?

Answer 17

-if pt has mechanical heart valves (target INR 2.5-3.5)
-if pt has heart valve disease (moderate/severe mitral valve stenosis) (target INR 2-3)

Question 18

What anticoagulation medication for afib is indicated in ESRD?

Answer 18

apixaban

Question 19

What drugs are indicated for acute ventricular rate control in afib if patient is hemodynamically stable + decompensated HF?

Answer 19

-amiodarone

Question 20

What drugs are indicated for acute ventricular rate control in afib if patient is hemodynamically unstable?

Answer 20

DCC (direct current cardioversion)

Question 21

What drugs are indicated for acute ventricular rate control in afib if patient is hemodynamically stable + no decompensated HF?

Answer 21

B-blockers, diltiazem, Verapamil
2nd line: digoxin
3rd line: amiodarone

Question 22

What drugs are indicated for long-term ventricular rate control in afib + HFrEF?

Answer 22

B-Blockers, 2nd line: digoxin

Question 23

What drugs are indicated for long-term ventricular rate control in afib (no HFrEF) ?

Answer 23

B-Blockers, Diltiazem, verapamil 2nd line: digoxin
-interaction between digoxin and verapamil

Question 24

What drugs are indicated for converting AF to SR (hemodynamically stable) ?

Answer 24

IV amiodarone, Ibutilide, procainamide (faster acting, higher risk of torsades des pointes)
-procainamide cannot be be administered with amiodarone or Ibutilide

Question 25

What drugs are indicated for converting AF to SR if pt has HFrEF?

Answer 25

IV amiodarone

Question 26

What is the dosing for dofetilide?

Answer 26

-monitor in hospital
-d/c if QTc > 500 ms or increases by > 15%
500 mcg BID = CrCl > 60 mL/min
250 mcg BID = CrCl 40-60 mL/min
125 mcg BID = CrCl 20-39 mL/min

Question 27

What are the adverse effects and monitoring parameters of amiodarone?

Answer 27

AE’s: blue-grey discoloration, photosensitivity, corneal microdeposits, pulmonary fibrosis, hepatoxicity, bradycardia, hypo/hyperthyroidism
Monitoring: TSH, LFTs, ECG, chest X-ray for pulmonary fibrosis (once when starting then if symptoms)

Question 28

What drugs are indicated for maintenance of SR following conversion for afib with normal LV function, no prior MI or significant structural heart disease?

Answer 28

Dofetilide, dronedarone, Flecainide, Propafenone
2nd line: Amiodarone 3rd line: Sotalol

Question 29

What drugs are indicated for maintenance of SR following conversion for afib with prior MI or significant structural heart disease, inlcuding HFrEF?

Answer 29

amiodarone, dofetilide, dronedarone
2nd line: Sotalol
-if pt is NYHA class III or IV then dronedarone is CI

Question 30

How do you administer Adenosine?

Answer 30

dose is 6 mg IV, then 12 mg IV then a second dose of 12 mg IV again

Question 31

How do you treat symptomatic PVCs and have no CAD or HF?

Answer 31

B-Blockers, diltiazem, verapamil
2nd line: antiarrythmic medication; catheter ablation

Question 32

How do you treat symptomatic PVCs w/HF?

Answer 32

B-Blockers

Question 33

How do you treat symptomatic PVCs w/CAD?

Answer 33

B-Blockers, diltiazem, or verapamil
2nd line: antiarrythmic medication

Question 34

What is the algorithm for termination of stable VT and structural heart disease?

Answer 34

DCC
2nd line: IV procainamide
3rd line: IV amiodarone or IV Sotalol

Question 35

What is the algorithm for termination of stable VT if no structural heart disease?

Answer 35

if Verapamil-sensitive VT then treat with Verapamil
If outflow tract VT then B-Blocker
if fails, then DCC

Question 36

What is indicated for ventricular fibrillation treatment?

Answer 36

Defibrillation
-use Epinephrine 1 mg IV then 2 does of Amiodarone 300 mg IV/Lidocaine 1-1.5 mg/kg IV (1/2 dose second time)