9 張先生56歲，因嚴重心臟衰竭至急診處，胸部X光及臨床診察變化為：肺充血（lung congestion） Kerley B line 腹水、肝腫大 下肢水腫（edema），則下列何者是最確切的右心衰竭特點？

ans 腹水、肝腫大 下肢水腫（edema）= more severe, so you can be sure to say that it is the right heart failure.

in lung congestion: this is the left heart failure.

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11 承上題，對於這位病患的不整脈，下列何種治療最為恰當？ATRIAL FIBRILLATION

Adenosine I.V. bolus Verapamil I.V. bolus D.C. cardioversion Digoxin I.V. bolus

ANS DC CARDIOVERSION

DIRECT CURRENT

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12 下列何種抗心律不整藥物之作用機轉與K（potassium）channel無關？

Quinidine Propafenone Sotalol Amiodarone

AND PROPAFENONE

Mechanism of action

Propafenone works by slowing the influx of sodium ions into the cardiac muscle cells, causing a decrease in excitability of the cells.

Class	Known as	Examples	Mechanism	Clinical uses [5]
Ia	fast-channel blockers	Quinidine Procainamide Disopyramide	(Na+) channel block (intermediate association/dissociation)	Ventricular arrhythmias prevention of paroxysmal recurrent atrial fibrillation (triggered by vagaloveractivity), *procainamide in Wolff-Parkinson-White syndrome
Ib		Lidocaine Phenytoin Mexiletine	(Na+) channel block (fast association/dissociation)	treatment and prevention during and immediately after myocardial infarction, though this practice is now discouraged given the increased risk of asystole ventricular tachycardia atrial fibrillation
Ic		Flecainide Propafenone Moricizine	(Na+) channel block (slow association/dissociation)	prevents paroxysmal atrial fibrillation treats recurrent tachyarrhythmias of abnormal conduction system. contraindicated immediately post-myocardial infarction.
II	Beta-blockers	Propranolol Esmolol Timolol Metoprolol Atenolol Bisoprolol	beta blocking Propranolol also shows some class I action	decrease myocardial infarction mortality prevent recurrence of tachyarrhythmias
III		Amiodarone Sotalol Ibutilide Dofetilide E-4031	K+ channel blocker Sotalol is also a beta blocker[6]	In Wolff-Parkinson-White syndrome (sotalol:) ventricular tachycardias and atrial fibrillation (Ibutilide:) atrial flutter and atrial fibrillation
IV	slow-channel blockers	Verapamil Diltiazem	Ca2+ channel blocker	prevent recurrence of paroxysmal supraventricular tachycardia reduce ventricular rate in patients with atrial fibrillation
V		Adenosine Digoxin	Work by other or unknown mechanisms (Direct nodal inhibition).	Used in supraventricular arrhythmias, especially in Heart Failure with Atrial Fibrillation, contraindicated in ventricular arrhythmias.