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Questions and Answers
What is the most common mechanism of ventricular tachycardia in patients with coronary artery disease?
What is the most common mechanism of ventricular tachycardia in patients with coronary artery disease?
Scar-mediated re-entrant VT
Delayed afterdepolarizations are associated with which type of ventricular tachycardia?
Delayed afterdepolarizations are associated with which type of ventricular tachycardia?
Idiopathic outflow tract VT
What arrhythmia is associated with early afterdepolarizations?
What arrhythmia is associated with early afterdepolarizations?
Torsades
What defines Group 1 pulmonary arterial hypertension (PAH)?
What defines Group 1 pulmonary arterial hypertension (PAH)?
Which class of antiarrhythmics can unmask the Brugada pattern?
Which class of antiarrhythmics can unmask the Brugada pattern?
How can the Brugada pattern be unmasked using EKGs?
How can the Brugada pattern be unmasked using EKGs?
How can VT or ICD shocks be suppressed in Brugada?
How can VT or ICD shocks be suppressed in Brugada?
What is the next best test after an Aldosterone: Renin ratio >30?
What is the next best test after an Aldosterone: Renin ratio >30?
What condition is indicated by systolic reversal of flow in the hepatic veins?
What condition is indicated by systolic reversal of flow in the hepatic veins?
Where is tissue Doppler typically higher?
Where is tissue Doppler typically higher?
What is 'annulus reversus'?
What is 'annulus reversus'?
What hemodynamic changes occur in patients with constrictive pericarditis during inspiration?
What hemodynamic changes occur in patients with constrictive pericarditis during inspiration?
What is long QT syndrome type 1 associated with?
What is long QT syndrome type 1 associated with?
What is a common cause of sudden cardiac death while swimming?
What is a common cause of sudden cardiac death while swimming?
______% variation in mitral inflow with respiration and a dilated IV is concerning for?
______% variation in mitral inflow with respiration and a dilated IV is concerning for?
What is included in the differential diagnosis of VT arising from the RVOT?
What is included in the differential diagnosis of VT arising from the RVOT?
What does the resting ECG of a patient with ARVC often show?
What does the resting ECG of a patient with ARVC often show?
What is the nature of the echo for ARVC?
What is the nature of the echo for ARVC?
What does anomalous RCA from left coronary sinus increase the risk of?
What does anomalous RCA from left coronary sinus increase the risk of?
What management is needed for an LCA arising from the right coronary sinus?
What management is needed for an LCA arising from the right coronary sinus?
What are not associated with Raynaud's Phenomenon?
What are not associated with Raynaud's Phenomenon?
What vasoconstrictors increase afterload and may adversely decrease cardiac output?
What vasoconstrictors increase afterload and may adversely decrease cardiac output?
When can dobutamine be used?
When can dobutamine be used?
What is the most ideal choice for cardiogenic shock with low BP?
What is the most ideal choice for cardiogenic shock with low BP?
What are ionotropes with vasodilator effects?
What are ionotropes with vasodilator effects?
What is a pure vasodilator used as an afterload reducer in severe mitral regurgitation?
What is a pure vasodilator used as an afterload reducer in severe mitral regurgitation?
In which setting would an Isoproterenol challenge be useful?
In which setting would an Isoproterenol challenge be useful?
Which maneuver can help distinguish between Mobitz type 1 and type 2?
Which maneuver can help distinguish between Mobitz type 1 and type 2?
What is the next step after seeing a 2:1 block?
What is the next step after seeing a 2:1 block?
What does fibrofatty infiltration on cMRI indicate?
What does fibrofatty infiltration on cMRI indicate?
What is mid myocardial gadolinium enhancement indicative of?
What is mid myocardial gadolinium enhancement indicative of?
What does diffuse, subendocardial gadolinium enhancement indicate?
What does diffuse, subendocardial gadolinium enhancement indicate?
How would Takotsubo syndrome appear on cMRI?
How would Takotsubo syndrome appear on cMRI?
What is the duration of secondary rheumatic fever prophylaxis?
What is the duration of secondary rheumatic fever prophylaxis?
What are the different groups of pulmonary arterial hypertension (PAH)?
What are the different groups of pulmonary arterial hypertension (PAH)?
What is percutaneous mitral edge-to-edge MV repair referred to as?
What is percutaneous mitral edge-to-edge MV repair referred to as?
What is percutaneous MV commissurotomy also known as?
What is percutaneous MV commissurotomy also known as?
What is the primary management for mitral stenosis?
What is the primary management for mitral stenosis?
What qualifies as severe mitral stenosis?
What qualifies as severe mitral stenosis?
What is a contraindication to MV balloon valvuloplasty?
What is a contraindication to MV balloon valvuloplasty?
When should spironolactone be added?
When should spironolactone be added?
What does a pulmonary artery systolic pressure with exercise of >45 mm Hg suggest for patients with normal hemodynamics at rest?
What does a pulmonary artery systolic pressure with exercise of >45 mm Hg suggest for patients with normal hemodynamics at rest?
In a patient with CVA and recent MI with anterior Q waves, what is the likely source of the CVA?
In a patient with CVA and recent MI with anterior Q waves, what is the likely source of the CVA?
What are the echo findings in ARVC?
What are the echo findings in ARVC?
What is characterized by lymphocytic infiltration with fibrosis and noncaseating granulomas?
What is characterized by lymphocytic infiltration with fibrosis and noncaseating granulomas?
What is the histologic characteristic of hypertrophic cardiomyopathy (HCM)?
What is the histologic characteristic of hypertrophic cardiomyopathy (HCM)?
What is an aneurysm composed of?
What is an aneurysm composed of?
What does the Killip classification include?
What does the Killip classification include?
In Brugada syndrome, ICD is only helpful for which cases?
In Brugada syndrome, ICD is only helpful for which cases?
What is Marfan syndrome caused by?
What is Marfan syndrome caused by?
What are the causes of death immediately, 1 month, and 1 year post heart transplant?
What are the causes of death immediately, 1 month, and 1 year post heart transplant?
What are the most common causes of tricuspid regurgitation?
What are the most common causes of tricuspid regurgitation?
What is the most common cause of polymorphic ventricular tachycardia (PVT)?
What is the most common cause of polymorphic ventricular tachycardia (PVT)?
What are mutations in dystrophin associated with?
What are mutations in dystrophin associated with?
What are mutations in tafazzin associated with?
What are mutations in tafazzin associated with?
What gene mutation is associated with Arrhythmogenic RV cardiomyopathy (ARVC)?
What gene mutation is associated with Arrhythmogenic RV cardiomyopathy (ARVC)?
What is associated with myosin heavy chain mutations?
What is associated with myosin heavy chain mutations?
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Study Notes
Cardiology and Arrhythmias
- Most common mechanism of ventricular tachycardia in coronary artery disease: scar-mediated re-entrant VT.
- Delayed afterdepolarizations associated with idiopathic outflow tract VT.
- Early afterdepolarizations are mechanisms for Torsades de Pointes.
- Class 1C antiarrhythmics (e.g., flecainide, propafenone) can unmask Brugada pattern via sodium channel blockage.
Hemodynamics and Cardiac Conditions
- Pulmonary arterial hypertension (PAH) defined by mean PAP ≥25 mm Hg at rest and mean PCWP.
- Severe tricuspid regurgitation indicated by systolic reversal of flow in hepatic veins.
- Kussmaul's sign observed in constrictive pericarditis, with right heart pressures rising on inspiration.
- Significant variation (>30%) in mitral inflow with respiration could signal tamponade pathology.
Genetic Mutations and Syndromes
- Long QT syndrome type 1 caused by loss of function in K channel.
- Anomalous right coronary artery (RCA) from left coronary sinus increases sudden death risk.
- Changes in echocardiogram findings distinguish various cardiac diseases, such as ARVC with epsilon waves and RV dysfunction.
Management Strategies
- Management of Brugada syndrome includes quinidine to suppress ventricular tachycardia or ICD shocks.
- For effective management of mitral stenosis (MS), percutaneous repair is often preferred.
- In cardiogenic shock with low blood pressure, Levophed is the ideal choice due to its potency as a vasopressor.
Diagnostic Procedures and Tests
- Oral sodium loading or saline infusion tests recommended following an Aldosterone: Renin ratio >30.
- Carotid sinus massage used to differentiate between Mobitz type 1 and 2 AV blocks.
- Isoproterenol challenge aids in diagnosing ventricular arrhythmias associated with ARVC.
Clinical Findings and Imaging
- Fibrofatty infiltration in cMRI indicates arrhythmogenic right ventricular cardiomyopathy.
- Mid-myocardial gadolinium enhancement on cMRI seen in myocarditis.
- Diffuse, subendocardial gadolinium enhancement indicative of cardiac amyloidosis.
Risk Factors and Complications
- Mutations in dystrophin linked with muscular dystrophy and dilated cardiomyopathy.
- Factors leading to tricuspid regurgitation include pulmonary hypertension and pacemaker lead placement.
- Pregnant patients with echocardiographic findings of significant mitral inflow variation should be assessed for potential tamponade.
Important Notes on Sudden Cardiac Events
- Sudden cardiac death can occur during swimming in patients with long QT syndrome.
- The risk of primary graft failure is highest within a month post-heart transplant, while cellular rejection is a primary concern immediately and after one year.
- Early management strategies for syncope related to reflex mechanisms include physical counter-maneuvers.
Miscellaneous
- Marfan syndrome inherits implications on connective tissue, predominantly caused by mutations in the fibrillin-1 gene (FBN1).
- Myotic heavy chain mutations may result in hypertrophic or dilated cardiomyopathy.
- The Killip classification serves as a clinical guide for assessing heart failure severity, ranging from no symptoms to cardiogenic shock.
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