Question 1
Question
Choose the incorrect statement.
Answer
-
2% of all people over age 65 in New Zealand have Afib.
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People with dysrythmias have a higher risk of mortality from MI, stroke, HF and dementia.
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Ventricular arrhythmias are less common than atrial fibrillation.
Question 2
Question
The mechanism of arrhythmia can be due to abnormal [blank_start]impulse[blank_end] firing or abnormal [blank_start]conduction[blank_end]. Abnormal impulse firing can be increased [blank_start]automaticity[blank_end] (where cells [blank_start]outside[blank_end] SA node start firing spontaneously) or [blank_start]triggered[blank_end] activity (where cells contract [blank_start]twice[blank_end] despite only being activated once).
Answer
-
impulse
-
conduction
-
automaticity
-
outside
-
triggered
-
twice
Question 3
Question
Bradyarrhythmias:
1. Sinus Bradycardia - Slow heart rate <[blank_start]60[blank_end] bpm(elderly, athletes).
• Increased vagal tone or stimulation, vomiting, myocardial ischemia or MI, [blank_start]hypo[blank_end]thyroid, hypo[blank_start]thermia[blank_end], increased [blank_start]intracranial[blank_end] pressure. Can be caused by drugs: Beta blockers (slow [blank_start]impulse firing[blank_end]) and/or non-dihydropyridine calcium channel blockers (slow [blank_start]conduction[blank_end]).
2. Sick Sinus Syndrome -
• A [blank_start]combination[blank_end] of bradycardia and tachycardia
• Sinus [blank_start]node[blank_end] dysfunction
• Associated with episodes of [blank_start]atrial[blank_end] tachyarrhythias
3. Atrio-Ventricular Block - impulses generated in atria are conducted [blank_start]slowly[blank_end] to ventricles or [blank_start]blocked[blank_end] partially/totally.
2 and 3 can be caused by [blank_start]BBs, CCBs, or digoxin[blank_end]
Answer
-
60
-
intracranial
-
hypo
-
thermia
-
impulse firing
-
conduction
-
combination
-
node
-
atrial
-
slowly
-
blocked
-
BBs, CCBs, or digoxin
Question 4
Question
Tachyarrhythmias:
1. Atrial flutter - Rapid, [blank_start]regular[blank_end] atrial depolarization. Atrial rate: 250-350 bpm. If atrial impulses are conducted to the [blank_start]ventricle[blank_end], it can result in ventricular tachycardia. Since atrial rate is high, AV [blank_start]block[blank_end] may occur to protect ventricles...
2. Atrial fibrillation - Most common sustained arrhythmia. mpulses conduct [blank_start]irregularly[blank_end] across the atria – leading to fibrillation. Atrial rate [blank_start]350-600[blank_end] bpm. AV node irregularly filters (blocks) atrial impulses, irregular increased [blank_start]ventricular[blank_end] rate occurs. Concern is atrial thrombus formation due to stasis. Clinical Features: Fatigue, palpitation, syncope, worsening [blank_start]heart failure[blank_end].
3. Ventricular Tachycardia - Rate [blank_start]100-250[blank_end] bpm. '[blank_start]Sustained[blank_end] VT' if tachycardia lasts >30 seconds. ECG: wide and rapid [blank_start]QRS[blank_end] complexes ([blank_start]monomorphic[blank_end]: All QRS complexes are similar, or [blank_start]polymorphic[blank_end]: QRS complexes change in morphology, amplitude, polarity).
4. Torsades de Pointes (TdP) - Variance of polymorphic VT. Drug causes: Anti-arrhythmics (Class Ia, Class III), phenothiazines, erythromycin. Electrolyte causes: [blank_start]hypokalemia[blank_end], hypomagnesemia.
5. Ventricular Fibrillation - Chaotic ([blank_start]irregular[blank_end]) ventricular arrhythmia. Rate 250-500 bpm. Follows ischemic event, most frequent cause of sudden [blank_start]death[blank_end].
6. Wolf-Parkinson-White Syndrome - Early ventricular depolarization. Congenital defect.
Answer
-
regular
-
ventricle
-
block
-
irregularly
-
350-600
-
ventricular
-
heart failure
-
100-250
-
Sustained
-
QRS
-
monomorphic
-
polymorphic
-
hypokalemia
-
irregular
-
death
Question 5
Question
Atrial Fibrillation - Classification:
• [blank_start]First detected[blank_end] =Only one diagnosed episode
• [blank_start]Paroxysmal[blank_end] = Recurrent episodes that stop on their own in <7 days
• [blank_start]Persistent[blank_end] = Recurrent episodes that last >7 days
• [blank_start]Permanent[blank_end] = Ongoing long-term episode
Answer
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First detected
-
Paroxysmal
-
Persistent
-
Permanent
Question 6
Question
Select all the options which could be clinical presentations of arrhythmia.
Question 7
Question
Vaughan Williams Classification of Anti-arrythmics:
• Class I - [blank_start]Sodium channel blockers[blank_end]
• Class Ia: Quinidine, Procainamide, Disopyramide (intermediate block)
• Class Ib: Lidocaine, Mexilitine (fast block)
• Class Ic: Flecainide, Propafenone, Moricizine (slow block)
• Class II - [blank_start]Beta adrenergic blockers[blank_end]
• Class III - [blank_start]Potassium channel blockers[blank_end]
- Amiodarone, Dronedarone, Sotalol, Ibutilide, Dofetilide
• Class IV - [blank_start]Calcium channel blockers[blank_end]
- Diltiazem, Verapamil
Question 8
Question
Choose the incorrect statement.
Answer
-
All sodium channel blockers (Class I) decrease conduction velocity and automaticity, but have different affects on the refractory period.
-
Beta blockers reduce conduction velocity and automaticity, and increase the refractory period.
-
Potassium channel blockers only affect refractory period, by increasing it.
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Calcium channel blockers reduce conduction velocity and automaticity, and increase the refractory period.
Question 9
Question
Diltiazem in patients post-MI with heart failure and flecainide post-MI to suppress ventricular ectopy both decrease mortality.
Question 10
Question
Choose the incorrect statement about lidocaine.
Answer
-
It is Class Ib.
-
It decreases depolarization, automaticity, and excitability of the ventricles during systole.
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It's onset of action occurs within 30-90 seconds.
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It can cause hypotension, arrhythmias, and heart block.
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It can cause sedation, dizzy, vision changes, seizures, parasthesia.
Question 11
Question
Which cardiac-related drugs are greatly affected by coadministration with Amiodarone?
Answer
-
Digoxin, Statins, Warfarin, Dabigatran
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Digoxin, ACEis, Warfarin, Rivaroxiban
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SSRIs, Dabigatran, Phenytoin
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Sulphonylureas and beta blockers
Question 12
Question
Treating ventricular arrhythmias:
Non sustained VT, no structural disease -
• [blank_start]Beta[blank_end] blockers, CCB, Class 1([blank_start]Na+[blank_end] blockers)
• Catheter [blank_start]ablation[blank_end]
VF or TdP (idiopathic) -
• [blank_start]ICD[blank_end]
Structural disease present -
• Treat [blank_start]underlying[blank_end] cause
• Catheter ablation or ICD
• [blank_start]Amiodarone[blank_end] when above fails
• Do not give [blank_start]CCBs[blank_end]
Answer
-
Beta
-
Na+
-
ablation
-
ICD
-
underlying
-
Amiodarone
-
CCBs
Question 13
Question
Select all the drug classes that target rhythm control instead of rate.
Answer
-
Class IV agents/Calcium Channel Blockers
-
Class II agents/Beta blockers
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Amiodarone
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Digoxin
-
Class I agents/Sodium channel blockers
-
Class III agents/Potassium channel blockers