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RCE Guidelines Studying > Laflamme- Chapter 6 (Arrhythmias) > Flashcards

Laflamme- Chapter 6 (Arrhythmias) Flashcards

1
Q

What are the three Arrhythmic mechanisms?

A

1) Abnormal Automaticity: Increase phase 4 diastolic depolarization
2) Reentry

3) Triggered activity:
- Early Afterdepolarization: Torsades
- Delayed Afterdepolarization: Digoxin posioning, Idiopathic VT, CPVT

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2
Q

What is RP interval cut off?

A

90 msec

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3
Q

What is definition of POTS?

A

Orthostatic tolerance with significant increase of HR in the first 10 mins after standing (HR > 120 or increase by 30 bpm)

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4
Q

What is heart block rate in AVNRT ablation? Recurrence rate?

A
  • Heart block: 1%

- Recurrence: 5%

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5
Q

What does left lateral pathway look like on ECG?

A

+V1, AVF

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6
Q

Left septal/Posterior pathway on ECG?

A

+V1, AVF

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7
Q

Right Septal pathway on ECG?

A

-V1, +AVL

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8
Q

Anterior or right lateral pathway on ECG?

A
  • V1, + aVF, + aVL
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9
Q

What are the two properties of a malignant accessory pathway?

A
  • Refractory period < 250 msec

- Able to maintain effective anterograde conduction of possible AF

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10
Q

What is the Mahaim pathway? What does the associated arrhyhthmia look like?

A
  • Accessory pathway in the lateral wall of the RV or to the right branch
  • Associated arrhythmia is antidromic AVRT with LBBB
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11
Q

What can you consider in a young patient with Lone AF?

A

EP Study: To eliminate other SVT degenerating into AFib (can be target for ablation)

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12
Q

Resting and walking HR for Afib rate control?

A
  • Resting < 100 bpm

- Walking < 110 bpm

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13
Q

Efficacy of Class 1C, Sotalol and Amio for Afib rhythm control at one year? What trial?

A

30%, 50%, 70%

CTAF trial

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14
Q

Name 8 complications of AFib ablation? What is total quoted rate?

A
  • 5%
  • Vascular complication, Cardiac perforation/Tamponade, TE, PV stenosis, Atrio esophageal fistula, Phrenic nerve palsy, Atypical flutter, Death
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15
Q

Name all 8 HASBLED risk factors?

A

HTN, Abnormal LE (ALT > 3x ULN), Cr > 200, Stroke, Bleeding history, Labile INR, Elderly > 65, Drugs associated with bleeding or Alcohol

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16
Q

How does Dabigatran work?

A

-Direct thrombin inhibitor

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17
Q

When to dose reduce Dabigatran?

A
  • > 75 y.o -> 110 mg BID
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18
Q

How to renally dose Rivaroxaban?

A

15mg if 15-50 crcl

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19
Q

How to renally dose Edoxaban?

A

30mg daily if CrCl 15-50

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20
Q

What is the reversal agent for Dabigatran?

A

-Idarucizumab

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21
Q

How to switch from INR to DOAC?

A
  • If INR < 2 -> switch right away

- If INR 2-3 -> start DOAC following day

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22
Q

How to switch from LMWH to DOAC? What about visa versa?

A

-Next schedule dose (for both)

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23
Q

How to switch from DOAC to Warfarin?

A

Stop doac when INR > 2.0

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24
Q

When to stop Apix, Riva and Dabigatran prior to surgery with high bleeding risk?

A
  • Apixaban and Rivaroxaban: 48h prior

- Dabigatran: >48h if CrCl > 80, >72h if CrCl > 50, >96h if CrCl >30

25
What did the ASSERT Trial show?
Detection of SCAF (HR > 190 and duration > 6min) associated with increased TE risk Espisodes > 17.7 significantly increased stroke risk (5x)
26
What did the TRENDS trial show?
SCAF > 5.5h associated with increased TE risk
27
What are the 4 brugada criteria?
0. Structural heart disease 1. Precordial concordance, absence of RS complexes 2. RS interval > 100msec in 1 of more precordial lead 3. AV dissociation 4. Morphological criteria V1-V2 and V6
28
What are the ECG criteria of the Schwartz score?
- QTC > 480 (3), QTC > 460 (2), > 450 (males, 1) - Tdp (2) - Alternating T wave (1) - Notched T wave on 3 leads (1)
29
What are two clinical criteria of Schwartz score?
- Syncope on exercise | - Syncope without stress
30
What are other components of Schwartz score?
- QTc ( >480, 460-470, 450) - TDP - T wave alternans - Notched T wave in 3 leads - Low heart rate for age - Syncope (With stress or without) - Congenital deafness - Family members with LQTs - Unexplained SCD below age 30
31
What is Gene mutation in LQT1, LQT2 and 3
- KCNQ1 (Loss of function) - KCNH2 (Loss of function) - SCN5a (Gain of function)
32
What are triggers for LQT1, 2 and 3?
1) Exercise, swimming, stress 2) Alarms, noise 3) Rest or sleep
33
Describe ECG morophology in LQT1 2 and 3
- Wide based T wave - Notched or biphasic T wave - Long isoelectric line with narrow based T wave
34
What are three RF for SCD in LQT?
- QTc > 500 - Complex ventricular arrhythmia - Jervell and Lange Nielsen
35
What is definition of Carotid Sinus Massage?
-Ventricular asystole > 3s
36
What to monitor for quinidine?
- QRS increase | - Increase QTc
37
What are 5 adverse effects of Procainamide?
- drug induced Lupus - Arrhyhtmogenic - Torsades/increased QTc - Negative inotropic agent with high doses - Hypotension
38
3 adverse effects of Disopyramide?
- Negative inotrope - Increased HR - Vagal tone: Urinary retention, constipation
39
Amiodarone side effects and incidence?
- Pulmonary toxicity (2%): BOOP, COP, ARDS, Restriction - GI toxicity (30%): Nausea, anorexia. AST, ALT 2x normal - Hypothyroidism (20%): Continue amiodarone, supplement levothyroxine. - Hyperthyroid (10%): Iodine load, destruction. Stop amiodarone, consider PTU.Methimazole or Prednisone - Skin: Photosensitivity (75%), blue discoloration - CNS: Ataxia - Opthalmic: Halo, Opti meuropathy - Cardiac: Bradycardia, increased defibrillation threshold.
40
11 drugs that interact with Amiodarone?
-Warfarin (need to reduce warfarin by 30-40% when starting Amiodarone) - Digoxin - Procainamide - Disopyramide - Diltiazem - Flecaniade - Phenytoin - Cyclosporine - Simvastatin - Atorvastatin
41
What is monitoring schedule for Amiodarone?
- Baseline CXR - TSH and free T3+T4 -> q6 months - LFT -> q6 months - CXR -> annual - Optho exam - Renal function - ECG
42
3 studies that show minimal RV pacing improves results?
- MOST - DAVID - CTOPP
43
What happens if P-P interval is less than upper rate limit?
-Electronic wenckebach
44
What happens if PP interval is less than Total Atrial Refractory period?
- 2:1 block | - The frequency of 2:1 block = 60 000 / TARP
45
What is Hysteresis?
Lower rate limit drops after V sense event
46
What is Dynamic AV delay and what is it used for>
-AV delay decreases at higher HR (Decreased TARP), useful in patients with AV block and 2:1 block on exercise
47
What is mode switch?
-DDD more switches to DDI mode following atrial tachyarrhythmia to prevent tracking of this tachyarrhythmia
48
What is ventricular safety pacing ?
-Following atrial pacing -> early ventricular pacing in the presence of a ventricular event detected inside the cross-talk detection window (Prevents asystole in the presence of cross-talk or preventing R on T in the presence of PVC)
49
What are 8 causes of Capture failure?
``` Lead migration Exit block Myocardial infarction/CMO/Metabolic (increased threshold) Lead fracture Lead insulation defect Loose set screw Battery depletion Ineffective autocapture algorithm ```
50
What are 10 causes of undersensing?
- Inadequate intrinsic signal like PVC or APC - Signal modification due to same as capture issues - High sensitivity programming - Lead migration - Lead perforation - Lead fracture - Insulation defece - Noise response - Magnet - Functional undersensing
51
What are 6 reasons for oversensing?
- Cross talk - Far field oversensing (QRS detected as an atrial event) - Oversensing of T wave - Electromagnetic interference - Myopotentials (unipolar only) - Lead issues
52
What are 4 risk factors for Pacemaker mediated tachycardia?
- PVC with retrograde conduction - Atrial capture failure - Very long programmed AV delay - Atrial oversensing or undersensing
53
What are three ways to prevent or terminate PMT?
- Prolong PVARP - Extension of post-PVC PVARP - 1 cycle without V pace following A sense during PMT
54
What is a class 1 and 4 class IIa indications for CRT?
- (1): LVEF M 35% NYHA II-IV + SR + LBBB + QRS > 150 msec - IIa: As above but QRS 120-149msec, Anything other than LBBB > 150msec, BiV pacing after Afib AV ablation, LVEF <35% with VPace > 40% according to DAVID
55
What does ECG look like in CRT pacing?
- V1: Dominant R wave | - 1: Negative
56
What are indications for ICD for primary prevention? (3)
- LVEF < 35% II-III - LVEF < 30% I - LVEF < 40% + NSVT + Inducible VT - 40 days post MI and > 3 months post revascularization
57
What are 7 reasons for Inappropriate ICD shock?
- Lead issues - SVT - T wave oversensing - Atrial far field - Myopotentials - Electromagnetic interference - R wave double counting
58
Indications to ablate an asymptomatic patient with WPW?
-High risk job that precludes employment (SVT 2015) - High risk findings on EPS: a) Induced Afib with R-R < 250 msec b) presence of multiple pathways c) refractory period < 240 msec d) the ability to provoke sustained AVRT e) the finding of AVRT precipitating Afib

RCE Guidelines Studying (52 decks)

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