superventricular arrhythmias - sinus ___ and ___ - ___ block - atrial ___ - supraventricular ___

- bradycardia, tachycardia - AV - fibriliation - tachycardia

15 AFib Flashcards by Reagan Smith

Normal ECG Values

PR ___ - ___ ms
QRS ___ - ___ ms
QT ___ - ___ ms
QTc ___ - ___ ms (men)
QTc ___ - ___ ms (women)

120-200
80-120
380-460
360-450
360-460

nervous for TdP around 500

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Torsades de Pointes

when QTc interval is greater than ___ ms, there is increased risk of drug induced arrhythmia (TdP)
- drug induced
- cause sudden cardiac ___

500
death

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what is this?

TdP

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drugs that may cause TdP
- 5 A’s
- opioids

antiarrhythmics
antimicrobials
antidepresents
antipsychotics
anticancer

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superventricular arrhythmias

sinus ___ and ___
___ block
atrial ___
supraventricular ___

bradycardia, tachycardia
AV
fibriliation
tachycardia

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ventricular arrhythmias

___ ventricular compexes
ventricular ___ and ___

premature
tachycardia, fibrillation

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superventricular arrhythmias

sinus bradycardia
- HR < ___ bpm
- impulses originating in ___ node (decreased)

60
SA
automaticity

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what is this

superventricular arrhythmias
- sinus bradycardia

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supraventricular arrhythmias - sinus bradycardia

etiologies/risk factors
- MI/ischemia
- abnormal SNS/PSNS tone
- electrolytes abnormalities ( ___ and ___ )

drugs
- dig
- BB
- CCB ( ___ and ___ )
- amiodarone, dronedarone
- ivabradone

K, Mg
verapamil, diltiazem

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supraventricular arrhythmias - sinus bradycardia

symptoms

hypotension
dizziness
syncope

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supraventricular arrhythmias - sinus bradycardia

treatment
only necessary if patient is ___
- ___ 0.5-1 mg IV, repeat every 5 min

AE: ___ cardia, urinary retention, ___ vision, dry mouth, mydriasis

anti-muscarinic: cant pee, cant see, cant spit

symptomatic
atropine
tachycardia, blurred

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supraventricular arrhythmias - sinus bradycardia

treatment is not responsive to atropine
- transcutaneous pacing
- ___ (5-20 mcg/kg/min) or ___ (0.1-0.5 mcg/kg/min)
- ___ 20-60 mcg IV bolus followed by doses of 10-20 mcg or infusion of 1-20 mcg/min

dopamine
epinephrine
isoproterenol

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supraventricular arrhythmias - sinus bradycardia

treatment after heart transplant or spinal cord injury
- ___ 6 mg/kg IV over 20-30 min OR
- ___
- (heart transplant) 300 mg IV followed PO 5-10 mg/kg/day titrated to effect
- (spinal cord injury) PO 5-10 mg/kg/day titrated to effect

aminophylline
theophylline

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supraventricular arrhythmias - sinus bradycardia

long term treatment
- some patients require a permanent ___

pacemaker

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supraventricular arrhythmias - atrial fibrillation

atrial activity - chaotic and disorganized
ventricular rate: 120-180 bpm
rhythm: irregularly irregular
___ waves: absnet

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what is this?

Afib

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Afib

stage 1) presence of modifiable and nonmodifiable risk factors assocaited with AF

stage 2) pre-atrial fib - ___ or ___ findings that further predispose patients to AF

stage 3)
- A) paroxysmal
- B) persistent
- C) long standing persistent
- D) successful ___

stage 4) permanent

electrical, structural
ablation

Afib

mechanisms
- abnormal atrial/pulmonary vein ___
- atrial ___

automaticity
re-entry

Afib

etiologies of reversible Afib
hyper ___
thoracic surgery
- CABG
- lung resection
- esophagectomy

hyperthyroidism

Afib

mortality
- stroke/systemic embolism - 5x increased risk
- HF - increased 3x risk
- dementia - 2x increased risk
- mortality - 2x increased risk

Afib goals of therapy

1) prevent ___ /systemic ___

___ ventricular response by inhibiting conduction of impulses to ventricles

convert Afib to ___

reduce ___ of episodes

stroke, embolism
slow
NSR
frequency

Afib - preventioini of stroke/systemic embolism

whats the CHAsDS2-VASc scoring

Afib - preventioini of stroke/systemic embolism

oral anticoag recommended for:
- ___ or greater (men)
- ___ or greater (women)

reasonable for
- ___ (men)
- ___ (women)

2
3
1
2

Afib - preventioini of stroke/systemic embolism

___ are preferred over warfarin for most patients

warfarin only preferred in Afib patients with
- ___ heart valves (INR 2.5-3.5)
- moderate to severe ___ valve stenosis (INR 2-3)

DOACs
mechanical
mitral

dabigitran, rivaroxaban, apixaban, edoxaban

# Afib - preventioini of stroke/systemic embolism warfarin or ___ are preferred in the following - end stage CKD (CrCl < ___ ) - hemodialysis

abixaban 15

# Afib - drugs of ventricular rate control MOA: direct AV node inh - CCB: ___ and ___ - BB: ___ , ___ , and ___ MOA: vagal stimulation/direct AV node inh - ___ MOA: BB and CCB activity - ___

- diltiazem, verapamil - propranolol, metoprolol, esmolol - digoxin - amiodarone

# Afib - drugs of ventricular rate control (IV) if not stable, shock if stable, do the have HF? - if yes: ___ - if no: __ , ___ , or ___ (if that doesnt work, dig, if that doesnt work, ___ )

- amiodarone - BB, verap, dilt - ami

# Afib - drugs of ventricular rate control (IV) goal: < ___ - ___ bpm AND ___ **do not administer ___ or ___ to patients with decomp HF**

100-110, asymptomatic - dilt, verap

# Afib - drugs of ventricular rate control (PO) EF < 40 - ___ - if doesnt work: ___ EF >40 - ___ , ___ , or ___ - if doesnt work: ___ | **do not administer ___ or ___ to patients with HFrEF**

- BB - dig - BB, dilt, vera - dig | dilt, verap

T or F: we can convert pateints with stage 4 Afib back to NSN

F they are permanently stuck like that

# Afib - conversion to NSN if AF has been present < 48 hours, conversion is safe if > 48 hours, conversion to NSN chould not be performed until patient has been ___ for 3 weeks (TEE can also rule out clot)

anticoagulated

# Afib - conversion to NSN DC cardioversion drugs (5) ___ (class I-IV) ___ (class III) - risk of TdP ___ (class 1A) - risk of TdP pill in pocket ___ and ___ (class 1C)

- amiodarone - ibutilide - procainamide - flecanide, propafenone

# Afib - conversion to NSN drugs normal LVEF - IV ___ or ___ - **or** ___ EF < 40 - IV ___ AF occuring outiside of hospital in patients with normal LVEF (pill in the pocket) - ___ and ___

- amiodarone, ibutilide - procainamide - amiodarone - felcainide, propafenone

# Afib - conversion to NSN drugs do not administer procainamide if patient has already recieved amiodarone or ibutilide due to the risk of excessive ___ prolongation and ___

QTc, TdP

# Afib - maintenance of sinus rhythm/prevention of recurrence drugs (6) ___ and ___(class I-IV) ___ and ___ (class III) ___ and ___ (class 1C)

- amiodarone, dronedarone - sotalol, dofetilide - flecainide, propafenone

# Afib - **dofetilide dose** CrCl > 60: ___ mcg PO BID CrCl 40-60: ___ mcg PO BID CrCl 20-39: ___ mcg PO BID CrCl < 20: ___ 2-3 h after 1st dose, check ___ interval - less than 15% increase, continue current dose - greater than 15% or greater than 500 ms, cut dose in half if > 500 ms any time after 2nd dose, D/C | proceed with first dose only if < 440 ms

500 250 125 CI

# Amiodarone - monitoring - hyper/hypo ___ - hepatotoxicity - ___ interval prolongation - pulmonary ___ - ___ microdeposits - dermatologic blue/grey, photosensitivty

- thyroidism - QTc - fibrosis - corneal

# Afib - maintenance of NSR following conversion/paroxysmal AF normal LV, no prior MI or structutal HD - ___ , ___ , ___ , or ___ - if doesnt work: ___ - if doesnt work: ___ (least preferred) prior MI, structial HD, HFrEF - ___ or ___ - if doesnt work: ___ NYHA III or IV or recent decom HF - no: ___ - yes ___ CI

- dofetilide, dronedarone, flecainide, propafenone - amiodarone - sotalol - amiodarone, dofetilide - sotalol - dronedarone, dronedarone

neither ___ nor ___ should be administered to patients with prior MI, significant structrual HD, and/or HFrEF

flecainide, propafenone | negative inotropes

# Afib - sotalol dose - CrCl > 60 - 80 mg ___ - CrCl 40-60 - 80 mg ___ 2-4 h after, check ___ interval - if < 500 ms after 3 days, increase, pt can be discharged or dose can increase to ___ daily - if > 500 ms: ___ | only do first dose if < 450 ms

- BID - daily - QTc - 120 - D/C

# Afib catheter ablation - used for pts who found anti-arrhythmic drugs ineffective, CI, or not preferred - selected patients are younger, less comorbidities - symptomatic ___ Afib first line to prevent from progression to persistent

paroxysmal