Antiarrhythmic Drugs and Cardiac Electrophysiology
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Questions and Answers

What do wide or notched P waves in lead II indicate in dogs and cats?

  • Left ventricular enlargement
  • Right atrial enlargement
  • Right ventricular enlargement
  • Left atrial enlargement (correct)

What do tall R waves in leads with the positive electrode on the left and/or caudal aspect of the body indicate?

  • Left ventricular enlargement (correct)
  • Right atrial enlargement
  • Right ventricular enlargement
  • Left atrial enlargement

Why is electrocardiography considered to be very insensitive at identifying mild to moderate changes in chamber size?

  • Because it is unable to detect severe enlargement
  • Due to the presence of false-positive findings
  • Due to the absence of waveform abnormalities in chamber enlargement
  • Because of its unacceptably low level of accuracy (correct)

What is the role of the sinus node in a healthy animal's heart?

<p>It is known as the normal pacemaker of the heart (C)</p> Signup and view all the answers

Which type of arrhythmia is most commonly due to a reentrant loop within the atria and is typically characterized on the ECG by a 'saw-toothed' baseline with relatively normal QRS complexes?

<p>Atrial flutter (A)</p> Signup and view all the answers

What is the most common drug used in long-term treatment of supraventricular tachycardia (SVT) in dogs and cats?

<p>Diltiazem (A)</p> Signup and view all the answers

In which species, dogs or cats, is third-degree AV block often produces no clinical signs and thus requires no treatment?

<p>Cats (C)</p> Signup and view all the answers

What should be implanted in dogs with third-degree AV block regardless of clinical signs?

<p>Pacemaker (D)</p> Signup and view all the answers

What is the consecutive occurrence of a series of supraventricular premature complexes called?

<p>Supraventricular tachycardia (SVT) (C)</p> Signup and view all the answers

Which drug is the most commonly used intravenously to 'break' supraventricular tachycardia into sinus rhythm?

<p>Diltiazem (C)</p> Signup and view all the answers

What is the most common treatment for an accessory pathway (bypass tract) that may result in supraventricular tachycardia?

<p>Radiofrequency catheter ablation (C)</p> Signup and view all the answers

At what rate does supraventricular tachycardia (SVT) most commonly range in dogs?

<p>~200 bpm (B)</p> Signup and view all the answers

What is the loading dose of amiodarone for dogs and cats?

<p>8–10 mg/kg, PO, every 12 hours for 7–10 days (C)</p> Signup and view all the answers

What are premature complexes that originate from ectopic sites above the ventricles called?

<p>Supraventricular premature complexes (A)</p> Signup and view all the answers

What is the treatment of choice for animals with chronic bradyarrhythmias due to AV block or sick sinus syndrome?

<p>Pacemaker implantation (C)</p> Signup and view all the answers

What is an accessory pathway (bypass tract) in relation to the normal electrical connection between an atrium and a ventricle called?

<p>Aberrant pathway (C)</p> Signup and view all the answers

What is the dosing regimen for atropine when administered orally to animals?

<p>0.04 mg/kg, PO, every 6–8 hours (D)</p> Signup and view all the answers

In which species are pacemakers implanted successfully, although only rarely, other than dogs and cats?

<p>Horses (C)</p> Signup and view all the answers

Which medication may be administered if pacemaker implantation is not a viable option for animals with chronic bradyarrhythmias?

<p>Phosphodiesterase (PDE) inhibitors (A)</p> Signup and view all the answers

What can occur if third-degree AV block is not identified before anesthesia in cats?

<p>Fainting leading to pacemaker implantation (C)</p> Signup and view all the answers

Which of the following is a characteristic of atrial standstill?

<p>Usually caused by hypokalemia (C)</p> Signup and view all the answers

What is the principal problem in animals with sick sinus syndrome?

<p>Destroyed SA node (A)</p> Signup and view all the answers

What is a possible effect of administering sympathomimetics to increase heart rate in animals with sick sinus syndrome?

<p>Temporary increase in heart rate (C)</p> Signup and view all the answers

What type of AV block is characterized by occasional P waves that are not followed by QRS complexes?

<p>Second-degree AV block (D)</p> Signup and view all the answers

What is the range of heart rate in dogs with persistent atrial standstill?

<p>40–65 bpm (C)</p> Signup and view all the answers

What is the most likely outcome of administering parasympatholytics to increase heart rate in animals with sick sinus syndrome?

<p>Decrease in heart rate (D)</p> Signup and view all the answers

Which valve keeps blood flowing from the atria to the ventricles?

<p>Atrioventricular valve (C)</p> Signup and view all the answers

What is the effect of persistent atrial standstill on the sinus node?

<p>'Is destroyed and replaced by AV nodal (junctional) escape rhythm (D)</p> Signup and view all the answers

What is the typical range of ventricular rhythm in dogs with atrial fibrillation?

<p>150-300 bpm (D)</p> Signup and view all the answers

What characterizes the ECG of dogs and cats with atrial fibrillation?

<p>Normal-appearing QRS complexes and irregular ventricular rhythm (C)</p> Signup and view all the answers

How is the ventricular rate controlled in most dogs and all cats with atrial fibrillation?

<p>By a combination of diltiazem and digoxin (A)</p> Signup and view all the answers

What drugs are used to prolong the refractory period of the AV node and slow AV nodal conduction?

<p>Diltiazem and atenolol (A)</p> Signup and view all the answers

In which dog breeds can atrial fibrillation develop with an otherwise normal heart?

<p>Irish Wolfhounds, Scottish Deerhounds, and Great Danes (D)</p> Signup and view all the answers

What is the goal of treatment of atrial fibrillation in most dogs and all cats?

<p>To control the ventricular rate (D)</p> Signup and view all the answers

Which method is most sensible for converting atrial fibrillation to sinus rhythm in dogs?

<p>Electrical cardioversion combined with amiodarone administration (A)</p> Signup and view all the answers

What can result from variation in the diastolic filling period of the ventricles due to irregular rhythm in animals with atrial fibrillation?

<p>Variability in stroke volume (C)</p> Signup and view all the answers

What do ventricular premature complexes (VPCs) arise from?

<p>'Specialized intraventricular conduction system' (A)</p> Signup and view all the answers

What distinguishes VPCs on ECGs?

<p>Wide QRS complex with large T wave that is opposite in polarity to the QRS complex (B)</p> Signup and view all the answers

What limits the use of amiodarone as a second-line treatment in animals?

<p>Hepatic and thyroid toxicoses (D)</p> Signup and view all the answers

What combination is often more effective than diltiazem alone for rate control in animals with atrial fibrillation?

<p>Diltiazem and atenolol (A)</p> Signup and view all the answers

What is the distinguishing feature of Mobitz type II second-degree AV block?

<p>No change in P-R intervals (C)</p> Signup and view all the answers

What distinguishes high-grade second-degree AV block from third-degree AV block?

<p>2:1 ratio of P wave to QRS complex (C)</p> Signup and view all the answers

What is the characteristic feature of third-degree AV block (complete heart block)?

<p>Absence of superventricular rhythm (D)</p> Signup and view all the answers

What can be indicated by waveform abnormalities in dogs and cats?

<p>Chamber enlargement (B)</p> Signup and view all the answers

What is the ideal treatment for high-grade second-degree AV block and third-degree AV block?

<p>Pacemaker implantation (A)</p> Signup and view all the answers

Which form of AV block is usually due to high vagal tone and is the most common type occurring in puppies?

<p>Mobitz type I second-degree AV block (D)</p> Signup and view all the answers

What distinguishes high-grade second-degree AV block from third-degree AV block?

<p>Presence of an association between QRS complexes and P waves in a 2:1 ratio or more (D)</p> Signup and view all the answers

What type of heart block may be present without outward evidence of cardiac disease?

<p>First-degree AV block (D)</p> Signup and view all the answers

What is the characteristic feature of Mobitz type I second-degree AV block?

<p>Progressively lengthening P-R intervals (A)</p> Signup and view all the answers

What is the distinguishing feature of third-degree (complete) AV block?

<p>Absence of association between QRS complexes and P waves (C)</p> Signup and view all the answers

What is the ideal treatment for symptomatic animals with high-grade second-degree AV block?

<p>Pacemaker implantation (A)</p> Signup and view all the answers

What might waveform abnormalities in dogs and cats indicate?

<p>Chamber enlargement (C)</p> Signup and view all the answers

What is the main reason that the sinoatrial node functions as the pacemaker of the heart?

<p>It depolarizes faster than the atrioventricular node. (C)</p> Signup and view all the answers

Which of the following conditions is characterized by the absence of P waves on the ECG for a short period?

<p>Sinus arrest (A)</p> Signup and view all the answers

What does sinus bradycardia refer to in animals?

<p>A regular sinus rhythm that is slower than expected for a given species and situation. (C)</p> Signup and view all the answers

What can be a cause of sinus tachycardia in animals?

<p>Stress (C)</p> Signup and view all the answers

What is respiratory sinus arrhythmia characterized by?

<p>An increase in heart rate with inspiration and a decrease with expiration. (D)</p> Signup and view all the answers

What happens during sinoatrial block on the ECG?

<p>The P-P interval surrounding the break in sinus rhythm is an exact multiple of the normal P-P interval. (C)</p> Signup and view all the answers

In which animal is sinus arrhythmia considered abnormal in the hospital setting?

<p>Cats (D)</p> Signup and view all the answers

What may be considered for treatment of bradycardia in dogs and cats?

<p>Administration of atropine (A)</p> Signup and view all the answers

What is a characteristic of sinus arrest (sinoatrial arrest, sinus pause)?

<p>It is diagnosed when there are shorter P-P intervals than normal. (C)</p> Signup and view all the answers

What may be administered to resolve the underlying cause of sinus tachycardia?

<p>Beta-blocker (eg, atenolol) (A)</p> Signup and view all the answers

What causes respiratory sinus arrhythmia in dogs?

<p>Variation in vagal tone intensity associated with respiration (B)</p> Signup and view all the answers

What does respiratory sinus arrhythmia refer to?

<p>An increase in heart rate with inspiration and a decrease with expiration. (A)</p> Signup and view all the answers

What is the most common tachyarrhythmia that is treated?

<p>Atrial fibrillation (C)</p> Signup and view all the answers

Which drug is generally preferred to control the ventricular rate in dogs with atrial fibrillation?

<p>Diltiazem (C)</p> Signup and view all the answers

Why is caution warranted when treating patients with Dilated Cardiomyopathy (DCM) with sotalol?

<p>It can worsen existing heart failure (D)</p> Signup and view all the answers

What is the target average heart rate suggested by the text for dogs using a Holter monitor?

<p>$ extless$ 125 bpm (A)</p> Signup and view all the answers

What can ventricular tachycardia degenerate into and cause?

<p>Ventricular fibrillation (C)</p> Signup and view all the answers

What is the primary role of most antiarrhythmic drugs?

<p>To control ventricular rate (C)</p> Signup and view all the answers

How are chamber enlargement indicated in dogs and cats according to the text?

<p>By absent waveform abnormalities (B)</p> Signup and view all the answers

What is the potential effect of some antiarrhythmics on congestive heart failure (CHF)?

<p>They worsen active CHF (D)</p> Signup and view all the answers

What is the role of an automatic implantable defibrillator in human medicine according to the text?

<p>It has reduced the use of some antiarrhythmics (B)</p> Signup and view all the answers

When does fast ventricular tachycardia make dogs most vulnerable to dying suddenly?

<p>When accompanied by severe underlying cardiac disease (A)</p> Signup and view all the answers

What medication combination can effectively decrease or stop episodes of syncope due to ventricular tachycardia in Boxers with ARVC, according to the text?

<p>Mexiletine and atenolol (C)</p> Signup and view all the answers

What does pacing the heart of a dog at a rate $ extgreater$180 bpm result in?

<p>Myocardial failure severe enough to cause CHF within weeks (A)</p> Signup and view all the answers

Which of the following best describes ventricular tachycardia?

<p>It can be divided into slower, benign ventricular tachycardias and faster, malignant ones. (D)</p> Signup and view all the answers

Which condition can commonly cause an accelerated idioventricular rhythm (AIVR) in dogs in the intensive care unit?

<p>Systemic disturbances related to anesthesia (D)</p> Signup and view all the answers

Which treatment effectively controls accelerated idioventricular rhythm (AIVR) in Boxers and usually stops syncope?

<p>Sotalol (B)</p> Signup and view all the answers

What distinguishes a ventricular escape rhythm from a ventricular tachycardia?

<p>Ventricular escape rhythm occurs because higher pacemakers have failed, while ventricular tachycardia doesn't. (B)</p> Signup and view all the answers

What is the primary cause of ventricular fibrillation as a terminal rhythm?

<p>Microreentrant circuits within the ventricular myocardium (A)</p> Signup and view all the answers

Which condition is most likely to cause nonsustained ventricular tachycardia in dogs and cats?

<p>Arrhythmogenic right ventricular cardiomyopathy (A)</p> Signup and view all the answers

What is a distinguishing feature of an accelerated idioventricular rhythm (AIVR) on an ECG?

<p>Relatively slow ventricular tachycardia (usually &lt; 200 bpm) (C)</p> Signup and view all the answers

What is the most prevalent cause of dilated cardiomyopathy (DCM) in dogs?

<p>Progressive loss of myocyte number and/or function (A)</p> Signup and view all the answers

What distinguishes ventricular tachycardia from an accelerated idioventricular rhythm (AIVR)?

<p>Ventricular tachycardia does not result in sudden death, while AIVR can be terminal. (C)</p> Signup and view all the answers

In which scenario does administration of sotalol or a combination of atenolol and mexiletine effectively control the arrhythmia?

<p>If it is causing hemodynamic instability (D)</p> Signup and view all the answers

Which statement best describes the occurrence of fusion beats on an ECG?

<p>They occur as hybrids of sinus beats and premature ventricular contractions. (B)</p> Signup and view all the answers

What distinguishes a ventricular escape rhythm from an idioventricular rhythm?

<p>A ventricular escape rhythm occurs because higher pacemakers have failed, while an idioventricular rhythm doesn't. (A)</p> Signup and view all the answers

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