Antiarrhythmics

(M1.CV.15.75) A 65-year-old female with a history of HTN, type 2 diabetes, and asthma presents to the emergency department with severe nausea, sweating, and shortness of breath. The emergency room physician obtains an EKG which is demonstrated in Figure A. She immediately receives treatment for her condition and is subsequently admitted to the cardiac intensive care unit (CICU). In the CICU, the patient has episodes of recurrent sustained ventricular tachycardia. The hospital is in short supply of amiodarone, so the attending physician starts lidocaine IV to prevent the development of an arrhythmia. Which of the following toxicities is associated with this medication?

(M1.CV.15.75) A 50-year-old male is being treated for ventricular arrhythmias and presents to the cardiologist, as he is concerned about the recent skin changes he has seen in his face (Figure A). Which of the following phases of the action potential is affected by this patient's medication (See Figure B)?

(M1.CV.13.99) A 50-year-old male is seen in your clinic. Physical examination reveals a resting heart rate of 120. You perform an ECG (the reading from the V5 lead is shown in Figure A). After reviewing the ECG, you decide to start the man on a medication that primarily reduces the rate of depolarization during phase 0 and the latter part of phase 4 in cardiac slow-response tissue. What is the medication?

(M1.CV.13.29) A 62-year-old man presents to the emergency department complaining of chest tightness. An electrocardiogram reveals ST segment elevation in the infero-lateral leads. He is treated for an acute myocardial infarction. His hospitalization is complicated by ectopy and several runs of non-sustained ventricular tachycardia. In an effort to reduce the risk of further arrhythmia in the post-myocardial infarction period, he is started on a Class 1 antiarrhythmic medication with very low affinity for its target channel. Which of the following images best represents the effect of the likely medication on the patient's action potential?

(M1.CV.13.9) A 63-year-old man with a history of hypertension and atrial fibrillation is brought into the emergency room and found to have a ventricular tachyarrhythmia. Ibutilide is discontinued and the patient is switched to another drug that also prolongs the QT interval but is associated with a decreased risk of torsades de pointes. Which drug was most likely administered in this patient?

(M1.CV.12.16) A 57-year-old woman with a history of diabetes and hypertension accidentally overdoses on antiarrhythmic medication. Upon arrival in the ER, she is administered a drug to counteract the effects of the overdose. Which of the following matches an antiarrhythmic with its correct treatment in overdose?

(M1.CV.12.110) A 58-year-old Caucasian male is being treated for atrial fibrillation and angina complains of dyspnea on exertion. On exam, his heart rate 104-115/min and irregularly irregular at rest. He has no chest pain. You believe his rate control for atrial fibrillation is suboptimal and the likely cause of his dyspnea. You are considering adding verapamil to his current metoprolol for additional rate control of his atrial fibrillation. Which of the following side effects should you be most concerned about with this additional medication?

(M1.CV.12.106) A 57-year-old Caucasian male presents to your office with heart palpitations and shortness of breath. On exam, he is tachycardic and his rhythm is irregularly irregular. He fails standard pharmacologic therapy and you refer to cardiology, where he is started on an antiarrhythmic medication. The action of this agent results in a longer action potential duration, an increased effective refractory period, and a longer QT interval. Which drug has been prescribed?