Rhythm and Conduction abnormalities part 3

Question 1

The most significant in left ventricular filling is

Answer 1

The shortening of diastole,
Because you fast ventricular rate and this means for the exactly same category of patients that depend on longer filling period they ill be more symptomatic

Question 2

CHAD-VASc

Answer 2

2 in men or 3 in women
2 points without sex for anticoagulation
1 point - anticoagulation/nothing

Question 3

when we decide to restore the sinus rhythm and when we try to control the ventricular rate

Answer 3

if no symptoms and esp in old pts -> rate control strategy
But if you are not completely sure ans esp the patient is young and there is subconsious adaptation to arrhythmia,pts sometimes unconsiously release the level of exercise and so on,you can try restore sinus rhythm and see if there is some improvement in exercise tolerance and if there is a case this means that the pt is not really asymptomatic
*IF SYMPTOMS ARE PRESENT WE MUST BE SURE THAT THEY ARE RELATED TO ARRHYTHMIA
if there are not related to arrhythmia then we should go for rate control especially in old pt,very dilated left atrium,very low propability of sinus rhythm

Question 4

embolic risk seems to be related to

Answer 4

embolic burden

Question 5

shorter episodes

Answer 5

less embolic risk

Question 6

electrical cardioversion

IV sedation

Answer 6

midazolam
propofol
etomidate

Question 7

Synchronous EEC/IEC

Answer 7

Anterior patch is placed in the right parasternal area and the posterior patch is placed in the left parasternal area

Question 8

Amiodarone is

Answer 8

slow conversion drug
best drug for prophylaxis - atrial fibrillation recurrence

it takes more than 12 hrs to see cardioversion

Question 9

you can use rate control temporarily until you decide if you will do cardioversion

Answer 9

or to gain sometime to facilitate spontaneous cardioversion or it could be
the first choice in pts with no symptoms

Question 10

Early Ablation in pts that

Answer 10

• not very dilated left atrium with high propablility or propability of recurrence, usually these are young pts with no previous history of AFib,no significant comorbidities or mildly controled
• normal LA or mildly dilated
• HF in pts ->produced or aggravated by atrial fibrillation,they have cardiomyopathy as a cause for HF or aggravating factor for HF.

Question 11

rhythm control

Answer 11

• try to restore sinus rhythm
• usually symptomatic pts
• cardioversion ,long term prophylaxy
• Antiarrhythmic drug
• PV isolation

Question 12

rate control

Answer 12

• pts asymptomatic or local ability to restore or maintain

sinus rhythm on the pts very dilated left atrium and so on

Question 13

post PVC pause is

Answer 13

compensatory

Question 14

pre PVC interval and post PVC interval is

Answer 14

double RR or PP during sinus rhythm beats

Question 15

The PVC usually doesnt

Answer 15

• reset the SA node so the next P wave will come to the right moment.
• can be one morphology or can be muultiple morphology
  sometimes PVC or VT can be narrower than baseline rhythm.

Question 16

ventricular arrhythmia provoke

Answer 16

wider QRS

Question 17

interopolated beat

Answer 17

the beat that increases the most the heart rate

Question 18

syncope more severe than

Answer 18

palpitations

Question 19

arrhythmias that comes from right ventricular outflow tract are almost never

Answer 19

benign,associated with sturural heart disease.

Question 20

arrhythmias that comes from left ventricular outflow tract

Answer 20

are not associated with structural heart diseases,if there associated is by chance

Question 21

We avoid class___ medication in pts with ischemic heart disease,left ventricular dysfunction or severe hypertrophy

Answer 21

I

Question 22

lidocaine associated

Answer 22

with increased mortality during acute phase of MI,you can use for e.g. in sustained VT to cardiovert a sustained VT with an intravenous bolus but prolonged perfusion to treat PVC is to be avoided because is associated with increased mortality

Question 23

if its focal arrhythmia ablation can be

Answer 23

curative

Question 24

VT : if it is < 30 sec (1)

if it is > 30 sec (2)

Answer 24

(1) it’s not sustained

(2) sustained VT

Question 25

Monomorphic VT

Answer 25

1. usually they are regular
2. AV dissociation, atrium is slow - ventricle is fast
3. Fusion beats
4. Capture beats
5. Morphological criteria

Question 26

Fusion beats

Answer 26

• they have a morphology thats its inbetween tachycardia and sinus rhythm
• usually narrower than tachycardia beat

Question 27

Capture beats

Answer 27

some of the P waves are able to go to go through AV nodal HIS and bundle branches and capture most of the myocardium and give rise to almost normal QRS complex

Question 28

Monomorphic VT and vast majority of cases are generated by

Answer 28

the re-entrant circuits,so if you capture all the myocardium , if you depolarise all the myocardium the tachycardia it will be stopped.The circuit remains excitable and the tachycardia continues

Question 29

when you BBB

Answer 29

somewhere depolarisation will be normal on the other side.
- If you have RBBB you will have normal left bundle conduction
-if you have LBBB you will have normal right bundle conduction
Somewhere in the endocardium depolarisation will start fast and only at the end of depolarisation will go through more specialised tissues

Question 30

Wide QRS SVT

Answer 30

• SVT + pre-existent BBB
• TSV with aberrant conduction
• SVT + antidromic AVRT ( WPW )

Question 31

ECG differentiation criteria VT - wide QRS SVT

Answer 31

1. Fusion beats : ventricualr captures
2. AV dissociation
3. VA retrograde conduction ( retrograde P )
4. QRS > 140 msec ( ESPECIALLY > 160 msec)
5. Unique morphology of QRS in chest leads =VT

Question 32

Most famous polymorphic VT : Torsades de points

Answer 32

long QT syndromes can be congenital but also can be acquired or both.

Question 33

medication that induces hypokalemia

Answer 33

Diuretics or some antiarrhythmic drugs

congenital long QT syndrome is rare

Question 34

Ventricular fibrillation

Answer 34

complelety chaotic activation of the ventricle,no significant mechanical activity.

• Polymorphic QRS that change continuously
• usually not compatible with life and in most instances isnt self- limited
• In 4-6 mins you have irreversible cerebral lesions

Question 35

In acute ischemia is not a sign of

Answer 35

reperfusion

this can be appear even with closed coronary artery

Question 36

Automatic idioventricular rhythm is a sign of reperfusion ?

Answer 36

NO ,there are other signs

Question 37

Before and after cardioversion you need to provide

Answer 37

provide CPR,intrahaling incubation or chest comperssion for cardiac massage

Question 38

implantable defribrillator works by

Answer 38

delivering high energy shock in an intracardiac lead

the lead has some small electrodes at the tip that are similar to pacing

Question 39

the most effective position for the defibrillator is in

Answer 39

the left precordial space,good waveform for defibrillation

Question 40

defibrillator

Answer 40

• this a device that can terminate ventricular arrhythmia

- can reduce the sudden cardiac death

Question 41

implantable cardioverter defibrillator ICD
INDICATION
Secondary prevention

Answer 41

, the pt has already experianced

sudden cardiac arrest,sustained ventricular arrhythmia that we were not able to find any reversible cause

Question 42

implantable cardioverter defibrillator ICD

Answer 42

in pts that havent experienced any ventricular arrhythmias but they are at high risk

• low ejection fraction
• Dilated cardiomyopathy with HF at least class II and severe left ventricular dysfunction
• some of the pts they have hypertrophic cardiomyopathy or arrhythmogenic cardiomyopathy : LQT , Brugada,SQT