Management of HF Part 2

Question 1

SCD definition

Answer 1

Sudden death that occurs within 1 hour of the onset of cardiac symptoms
An underlying cardiac cause is likely responsible

Question 2

2 ways to classify SCD

Answer 2

Asystole/Pulseless electrical activity

Ventricular tachycardia/fibrillation

Question 3

3 risk factors for SCD

Answer 3

Scar
Autonomic abnormalities
Repolarization abnormalities

Question 4

Implanted cardioverter-defibrillator (ICD)

Answer 4

Has full pacemaker capabilities
Has the ability to treat VT and VF
Must be capable of delivering thousands of times more energy than a pacemaker

Question 5

5 risks of an ICD

Answer 5

Implant complications
Inappropriate shocks
ICD lead fracture or failure
ICD battery/computer malfunction
Late infection

Question 6

Who would not benefit from an ICD

Answer 6

Life expectancy < 1 year

Patients who do not wish to be resuscitated

Question 7

Who should receive an ICD?

Answer 7

Prior VT/VF arrest
VT with structural heart disease (prior MI or low LVEF)
LVEF < 30%
LVEF 31-35% and ischemic cardiomyopathy

Question 8

Atrioventricular dyssynchrony

Answer 8

Timing between atrial and ventricular contractions is pertrubed
Not enough time for atrial contraction (treat by slowing the HR)
Too much time between A and V contraction (treat with pacemaker)

Question 9

LBBB and intraventricular dyssynchrony

Answer 9

Contraction of lateral wall is delayed compared to septum
Inefficient contraction with long term consequences (negative remodelling)
Wider QRS = greater dyssynchrony

Question 10

CRT Implant

Answer 10

Standard pacing lead in the RA and RV apex
LV lead inserted into a branch of the coronary sinus
For NYHA class 2-4, LVEF less than 35%, LBBB (QRS >130), or nonLBBB (QRS >150)