IBHRE Certification Study Guide on Syndromes and Clinical
Scenarios Comprehensive Exam Prep Solved 100% Correct
Brugada Syndrome - ANSWER-Common in SE Asia. Major cause of death in young,
Asian males. ST elevation in leads V1-V3. Appears like RBBB in pericardial leads.
VT appears more like Torsades than Polymorphic VT (the latter of which is often
proceeded by long-short intervals or rate acceleration)
Cardiac Tamponade - ANSWER-Hypotension, tach, and jugular venous distention.
Presents with electrical alternans
Chagas Disease - ANSWER-Parasitic disease. Incurable chronically. Prevalent in
Central and South America. Vector-borne. 60% remain asymptomatic. Can cause PVC,
VT/VF, SSS, CHB, CHF, SCD. Treated with Pacers/ICD/Amiodarone/Heart Transplant.
May cause host of neurological disorders as well.
Fentanyl Toxicity - ANSWER-Can be reversed with NARCAN. Fentanyl (used for
general anesthesia) may produce severe Brady, hypotension, respiratory depression.
Half-life of 17 hours.
Hematoma - ANSWER-Most common implant complication. Usually only requires
observation, unless there is arterial bleeding within pocket (evaluated by being large
enough to be palpitated). Blood thinners such as warfarin, aspirin, etc. make this worse.
May cause infection, so antibiotics may be given prophylactically.
HOCM - ANSWER-Bi-V pacing feasible and usually best configuration for gradient
reduction in this disorder. Bi-V pacing reduces LV hypertrophy.
Hyperkalemia - ANSWER-Increased pacing thresholds, double counting R waves,
under detection of VT/VF, T-wave oversensing
Hypothermia - ANSWER-The illness is a contraindication to pacing as the ventricles are
more prone to VF and less likely to successfully defib
Hypothermia - ANSWER-The illness is a contraindication to pacing as the ventricles are
more prone to VF and less likely to successfully defib
Long QT Syndrome - ANSWER-QTc > 500ms, or a 25 % increase in QT over baseline.
Can be causes by Class I or III antiarrhythmics, or by low Potassium. Cause of death in
10-15% of SIDS cases. ICD recommended. Propensity for syncope, Torsades, and
SCD.
Treat with beta blockers, Rate Smoothing to control EADs
Scenarios Comprehensive Exam Prep Solved 100% Correct
Brugada Syndrome - ANSWER-Common in SE Asia. Major cause of death in young,
Asian males. ST elevation in leads V1-V3. Appears like RBBB in pericardial leads.
VT appears more like Torsades than Polymorphic VT (the latter of which is often
proceeded by long-short intervals or rate acceleration)
Cardiac Tamponade - ANSWER-Hypotension, tach, and jugular venous distention.
Presents with electrical alternans
Chagas Disease - ANSWER-Parasitic disease. Incurable chronically. Prevalent in
Central and South America. Vector-borne. 60% remain asymptomatic. Can cause PVC,
VT/VF, SSS, CHB, CHF, SCD. Treated with Pacers/ICD/Amiodarone/Heart Transplant.
May cause host of neurological disorders as well.
Fentanyl Toxicity - ANSWER-Can be reversed with NARCAN. Fentanyl (used for
general anesthesia) may produce severe Brady, hypotension, respiratory depression.
Half-life of 17 hours.
Hematoma - ANSWER-Most common implant complication. Usually only requires
observation, unless there is arterial bleeding within pocket (evaluated by being large
enough to be palpitated). Blood thinners such as warfarin, aspirin, etc. make this worse.
May cause infection, so antibiotics may be given prophylactically.
HOCM - ANSWER-Bi-V pacing feasible and usually best configuration for gradient
reduction in this disorder. Bi-V pacing reduces LV hypertrophy.
Hyperkalemia - ANSWER-Increased pacing thresholds, double counting R waves,
under detection of VT/VF, T-wave oversensing
Hypothermia - ANSWER-The illness is a contraindication to pacing as the ventricles are
more prone to VF and less likely to successfully defib
Hypothermia - ANSWER-The illness is a contraindication to pacing as the ventricles are
more prone to VF and less likely to successfully defib
Long QT Syndrome - ANSWER-QTc > 500ms, or a 25 % increase in QT over baseline.
Can be causes by Class I or III antiarrhythmics, or by low Potassium. Cause of death in
10-15% of SIDS cases. ICD recommended. Propensity for syncope, Torsades, and
SCD.
Treat with beta blockers, Rate Smoothing to control EADs
