Cardiology Flashcards on Arrhythmias

Questions and Answers

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?

Idiopathic outflow tract VT

What arrhythmia is associated with early afterdepolarizations?

Torsades

What defines Group 1 pulmonary arterial hypertension (PAH)?

Mean PAP ≥25 mm Hg at rest Signup and view all the answers

Which class of antiarrhythmics can unmask the Brugada pattern?

Class 1C - Sodium channel blockers (Flecainide, Propafenone) Signup and view all the answers

How can the Brugada pattern be unmasked using EKGs?

Recording leads V1 and V2 in the second and third intercostal space Signup and view all the answers

How can VT or ICD shocks be suppressed in Brugada?

Quinidine (Class Ia antiarrhythmic drug with Ito and IKr blocker effects) Signup and view all the answers

What is the next best test after an Aldosterone: Renin ratio >30?

Oral sodium loading test, saline infusion test, fludrocortisone suppression, or captopril challenge. Signup and view all the answers

What condition is indicated by systolic reversal of flow in the hepatic veins?

Severe TR Signup and view all the answers

Where is tissue Doppler typically higher?

Medial mitral annulus than the lateral Signup and view all the answers

What is 'annulus reversus'?

Tethering of the lateral mitral annulus in severe constriction. Signup and view all the answers

What hemodynamic changes occur in patients with constrictive pericarditis during inspiration?

Right heart pressures rise rather than fall. Signup and view all the answers

What is long QT syndrome type 1 associated with?

Loss of function in K channel Signup and view all the answers

What is a common cause of sudden cardiac death while swimming?

Long QT syndrome Signup and view all the answers

______% variation in mitral inflow with respiration and a dilated IV is concerning for?

Greater than 30 Signup and view all the answers

What is included in the differential diagnosis of VT arising from the RVOT?

Monomorphic VT with LBBB, Idiopathic VT, Arrhythmogenic right ventricular cardiomyopathy (ARVC) Signup and view all the answers

What does the resting ECG of a patient with ARVC often show?

Epsilon wave after the QRS and T-wave inversions in V1-V3 (in the absence of RBBB) Signup and view all the answers

What is the nature of the echo for ARVC?

Echocardiogram with a regional wall motion abnormality of the right ventricle and fractional area change of 65 mm. Signup and view all the answers

What does anomalous RCA from left coronary sinus increase the risk of?

Sudden death due to decreased blood flow. Signup and view all the answers

What management is needed for an LCA arising from the right coronary sinus?

Surgical intervention regardless of symptomatic/asymptomatic. Signup and view all the answers

What are not associated with Raynaud's Phenomenon?

Heroin, cigarette smoking, and alcohol Signup and view all the answers

What vasoconstrictors increase afterload and may adversely decrease cardiac output?

Phenylephrine and vasopressin Signup and view all the answers

When can dobutamine be used?

In the setting of low cardiac output with preserved blood pressure. Signup and view all the answers

What is the most ideal choice for cardiogenic shock with low BP?

Levophed Signup and view all the answers

What are ionotropes with vasodilator effects?

Dobutamine and Milrinone Signup and view all the answers

What is a pure vasodilator used as an afterload reducer in severe mitral regurgitation?

Sodium nitroprusside Signup and view all the answers

In which setting would an Isoproterenol challenge be useful?

Arrhythmogenic right ventricular cardiomyopathy or as an adjunct to tilt table testing for syncope. Signup and view all the answers

Which maneuver can help distinguish between Mobitz type 1 and type 2?

Carotid sinus massage Signup and view all the answers

What is the next step after seeing a 2:1 block?

Differentiate between Mobitz type 1 and type 2 by doing a vagal maneuver. Signup and view all the answers

What does fibrofatty infiltration on cMRI indicate?

Arrhythmogenic right ventricular cardiomyopathy Signup and view all the answers

What is mid myocardial gadolinium enhancement indicative of?

Myocarditis Signup and view all the answers

What does diffuse, subendocardial gadolinium enhancement indicate?

Cardiac amyloidosis Signup and view all the answers

How would Takotsubo syndrome appear on cMRI?

No delayed gadolinium enhancement Signup and view all the answers

What is the duration of secondary rheumatic fever prophylaxis?

Not specified in the content. Signup and view all the answers

What are the different groups of pulmonary arterial hypertension (PAH)?

Group 1: idiopathic, heritable, drug- and toxin-related, or associated with connective tissue diseases, portal hypertension, HIV, or congenital disease. Group 2: secondary to left-heart disease. Group 3: secondary to lung disease or hypoxia. Group 4: due to thromboembolic and other pulmonary artery obstructive disease. Group 5: unclear and/or multifactorial etiology. Signup and view all the answers

What is percutaneous mitral edge-to-edge MV repair referred to as?

Mitral Clip Signup and view all the answers

What is percutaneous MV commissurotomy also known as?

Valvuloplasty Signup and view all the answers

What is the primary management for mitral stenosis?

Mostly percutaneous repair Signup and view all the answers

What qualifies as severe mitral stenosis?

MV area < 1.5 cm² Signup and view all the answers

What is a contraindication to MV balloon valvuloplasty?

Moderate to severe MR and left atrial thrombus Signup and view all the answers

When should spironolactone be added?

In refractory HTN, not in HFpEF with HTN Signup and view all the answers

What does a pulmonary artery systolic pressure with exercise of >45 mm Hg suggest for patients with normal hemodynamics at rest?

HFpEF Signup and view all the answers

In a patient with CVA and recent MI with anterior Q waves, what is the likely source of the CVA?

Likely LV thrombus. Next step: TTE (not cardiac monitoring to look for AFib). Signup and view all the answers

What are the echo findings in ARVC?

Right ventricular dilation, reduced RV function, and morphologic abnormalities. Signup and view all the answers

What is characterized by lymphocytic infiltration with fibrosis and noncaseating granulomas?

Sarcoidosis Signup and view all the answers

What is the histologic characteristic of hypertrophic cardiomyopathy (HCM)?

Myofibril disarray Signup and view all the answers

What is an aneurysm composed of?

Necrotic myocardium and fibrous tissue Signup and view all the answers

What does the Killip classification include?

Class I: No clinical signs of heart failure. Class II: Rales, an S3, and elevated jugular venous pressure. Class III: Acute pulmonary edema. Class IV: Cardiogenic shock or hypotension. Signup and view all the answers

In Brugada syndrome, ICD is only helpful for which cases?

Suspected arrhythmic syncope. Signup and view all the answers

What is Marfan syndrome caused by?

Mutations in the fibrillin-1 extracellular matrix protein gene (FBN1) Signup and view all the answers

What are the causes of death immediately, 1 month, and 1 year post heart transplant?

Immediately and 1 year: cellular rejection; Within 1 month: primary graft failure. Signup and view all the answers

What are the most common causes of tricuspid regurgitation?

Pulmonary HTN and pacemaker lead. Signup and view all the answers

What is the most common cause of polymorphic ventricular tachycardia (PVT)?

Acute myocardial ischemia. Signup and view all the answers

What are mutations in dystrophin associated with?

Muscular dystrophy and dilated cardiomyopathy. Signup and view all the answers

What are mutations in tafazzin associated with?

Dilated cardiomyopathy and left ventricular noncompaction. Signup and view all the answers

What gene mutation is associated with Arrhythmogenic RV cardiomyopathy (ARVC)?

Several genes encoding desmosomal proteins, including junctional plakoglobin. Signup and view all the answers

What is associated with myosin heavy chain mutations?

HCM or dilated cardiomyopathy. Signup and view all the answers

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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Description

Test your knowledge on key concepts of ventricular tachycardia and its mechanisms. This quiz covers important definitions and classifications related to arrhythmias, including scar-mediated re-entrant VT and Torsades. Perfect for medical students and healthcare professionals alike!