Workshop #1 (HRS)

Question 1

BBR VT

Answer 1

HV interval equal to or longer than in sinus

His to onset of QRS complex - first ventricular activation anywhere, including surface

Question 2

Bellhausen idiopathic LV tachycardia

Answer 2

RBBB
Left axis
Usually from L posterior fascicle

tx: CCB
Mappable
Distinguishing feature - Fascicular spike preceding

Question 3

Cardiac memory

Answer 3

Seen after:
Termination of arrhythmia
Pacing
Ablation

Presumably caused by change in cardiac ion channels due to aberrant mech of pacing. As timeframe to recover is timeframe of making new channels.

Question 4

Bidirectional VT

Answer 4

remember: ABCD

Andersen Tawil Syndrome (LQT7)
Bidirectional VT
CPVT
Digoxin toxicity.

CPVT:
Leaky RyR2 receptor

LQT7 - Andersen Tawil Sx

• periodic paralysis with K abn
• dystrophic changes
• prominent U waves
• Nasty PMVT, lots of PVC, Bidirectional VT

responds to flecainide: ATS, CPVT
Flecainide may plug leaky ryanodine receptors (also Coreg)

Question 5

Jeeves Lange Neilsen

Answer 5

Homozygous mutation if LQT1

Homozygous mutation of KCNQ1 channel or KCNE1 channel

Will get really really really long QT interval

Question 6

Exercise testing with LQTS (1,2,3)

Answer 6

LQT1: increase HR, QT will not shorten, paradoxically lengthening of QT.
(I Ks is makes AP shorter with adrenergic stimulation, however with mutation of I Ks makes AP longer with adrenergic stim - ?)

LQT2: exaggerated/funny looking Bifid T waves

LQT3: QT gets better because extra inward current (shorter AP - ?)

Question 7

Negative HV interval

Answer 7

Seen with LV re-entry (myocardial re-entry)

Also with Fascicular VT (RBBB, LAD, Tx:CCB)