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Cardiovascular System > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What are ectopic beats and what is the treatment for it?

A

This is missed beats.
Usually no treatment is required, but if troublesome, beta-blockers are usually used as they’re effective and safer than other suppressant drugs

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2
Q

What is Atrial Fibrillation?

A

A type of arrhythmia that causes irregular and often very rapid heart rhythm.

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3
Q

What are symptoms of atrial fibrillation ?

A

Shortness of breathe, dizziness etc

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4
Q

What is the aim of treatment for atrial fibrillation?

A

Reducing the symptoms and preventing complications by either controlling the ventricular rate (rate control) or restoring and maintaining sinus rhythm (rhythm control)

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5
Q

What must happen annually with all patients with atrial fibrillation?

A

Annually, anticoagulation, stroke and bleeding risk must be reviewed.

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6
Q

Patients with life threatening haemodynamic instability caused by new onset atrial fibrillation should undergo what?

A

Emergency electrical cardioversion

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7
Q

What should be done with patients with non life-threatening haemodynamic instability?

A

If onset of arrhythmia is less than 48 hours, rate or rhythm control can be offered

If onset is more than 48 hours, rate control only

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8
Q

What is the drug treatment for haemodynamic instability?

A

Intravenous amiodarone hydrochloride or flecainide acetate.

If the patient has structural heart disease, amiodarone hydrochloride is preferred

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9
Q

What can be given as urgent rate control?

A

A beta-blocker or verapamil hydrochloride, intravenously

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10
Q

What is preferred if atrial fibrillation has been present for more than 48 hours?
And what should be done beforehand?

A

Electrical cardioversion but only until the patient has been fully anticoagulated for at least 3 weeks.

If this is not possible, parenteral anticoagulation (heparin) should commence and left atrial thrombus should be ruled out immediately before starting cardioversion.

Rate control can also be offered before cardioversion.

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11
Q

What should be given after cardioversion?

A

Oral anticoagulants for at least 4 weeks

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12
Q

What is the preferred first line drug treatment for atrial fibrillation?

A

Rate control; such as:
- Diltiazem
- Verapamil
- Digoxin

NOT SOTATLOL

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13
Q

When can the first line treatment for atrial fibrillation not be used?

A

In patients with new onset atrial fibrillation.

In patients with atrial flutter that can be given ablation strategy

In patients with atrial fibrillation with a reversible cause

If rhythm control is more suitable

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14
Q

What drugs can control ventricular rate?

A
  1. A standard beta blocker except sotalol hydrochloride.
  2. A rate limiting calcium channel blocker such as diltiazem hydrochloride or verapamil hydrochloride as monotherapy
  3. Digoxin, but only for controlling ventricular rate at rest.
    This must be used as monotherapy in sedentary patients with non-paroxysmal atrial fibrillation

Digoxin is also used when atrial fibrillation is accompanied by congestive heart failure

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15
Q

What must be done if a single drug fails to control the ventricular rate?

A

A combination of two drugs can be used; including, beta-blocker, digoxin, diltiazem hydrochloride.

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16
Q

What should be done if symptoms are not controlled with a combination of two drugs?

A

A rhythm control strategy should be considered.
This includes:
- Beta blockers (NOT SOTALOL AS FIRST LINE)

  • Amiodarone
  • Dronedarone
  • Propafenone
  • Flecainide
  • Sotalol (just not as first line)
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17
Q

What should be done if ventricular function is diminished?

A

A combined of a beta blocker (that is licensed for use in heart failure) and digoxin is preferred.

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18
Q

What can be used if rhythm control (maintaining sinus rhythm) is needed after cardioversion?

A

A standard beta blocker

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19
Q

What should be given if a standard beta blocker cannot be used for rhythm control (maintaining sinus rhythm) after cardioversion?

A

An oral anti-arrhythmic drug such as sotatol hydrochloride, flecainide acetate, propafenone hydrochloride or amiodarone hydrochloride, or dronedarone

20
Q

What can be done to increase success of cardioversion procedure?

A

Amiodarone hydrochloride can be started 4 weeks before and continued for up to 12 months after the electrical cardioversion procedure

21
Q

Who should flecainide acetate and propafenone hydrochloride not be given to?

A

Patients with known ischaemic or structural heart disease.

22
Q

What should be considered for those with left ventricular impairment or heart failure?

A

Amiodarone

23
Q

What drug is used to control symptomatic paroxysmal atrial fibrillation?

A

A standard beta blocker, used to control ventricular rhythm

24
Q

What should be given if symptoms persist or a standard beta blocker is not appropriate in paroxysmal atrial fibrillation?

A

An oral anti-arrhythmic drug such as dronedarone, sotalol hydrochloride, flecainide acetate, propafenone hydrochloride or amiodarone hydrochloride

25
Q

When is the pill-in-the-pocket approach given?

A

In selected patients with infrequent episodes of symptomatic paroxysmal atrial fibrillation

26
Q

What is the pill-in-the-pocket approach?

A

When the patient takes oral flecainide acetate or propafenone hydrochloride to self treat an episode of atrial fibrillation

27
Q

What is the assessment tool used for stroke risk in atrial fibrillation?

A

CHA2 DS2 a VASc assessment tool

28
Q

What assessment tool is used to assess bleeding risk in atrial fibrillation patients prior to and during anticoagulation?

A

HAS-BLED tool

29
Q

What risk factors for stroke are taken into account by CHA2 DS2 VASc?

A
  • Prior ischaemic stroke
  • Transient ischaemic attacks
  • Thromboembolic events
  • Heart failure
  • Over 65
  • Diabetes
30
Q

Examples of beta blockers?

A
  • Atenolol (also called Tenormin)
  • Bisoprolol (also called Cardicor or Emcor)
  • Carvedilol
  • Labetalol (also called Trandate)
  • Metoprolol (also called Betaloc or Lopresor)
  • Propranolol
31
Q

What’s bradycardia, tachycardia and a normal heart rate?

A

Normal rate is 60-100bpm
Less than 60bpm is bradycardia
More than 60bpm is tachycardia

32
Q

What are the causes of arrythmia?

A
  • Coronary heart disease
  • Heart valve disease
  • Hypertension
  • Cardiomyopathy
  • Congenital abnormalities in the electrical pathways
33
Q

Symptoms of Arrythmias?

A
  • Palpitations
  • Abnormally fast, slow or irregular pulse
  • Dizziness or feeling faint
  • Shortness of breath
34
Q

What are the different types of arrythimias?

A
  1. Atrial Fib - the most common
  2. Atrial flutter
  3. Ectopic beats
  4. Paroxysmal atrial fibrillation
  5. Paroxysmal ventricular tachycardia
  6. Ventricular tachycardia
  7. Supraventricular tachycardia
35
Q

What are the treatment options for arrythmias?

A
  • Medication
  • Cardioversion
  • Artificial pacemakers
  • ICDs (Implantable cardioverter defibrillation)
36
Q

When can rate control not be given?

A
  • If pt has life threatening acute new onset AF
  • Secondary heart failure where rhythm control is more suitable based on clinical judgement
37
Q

What should be given to acute new onset of AF that is life threatening?

A

Rhythm control should be given via emergency electrical cardioversion

38
Q

What should be given to acute new onset of AF that is life threatening?

A

If onset is less than 48 hours - rate or rhythm control

If onset is uncertain or more than 48 hours - rate control is preferred; as rhythm control can cause a stroke

39
Q

What is the Vaughn-Williams classification?

A

Class 1 - Membrane stabilising drugs (Sodium channel blockers):
- Lidocaine, flecainide

Class 2 - Beta blockers

Class 3 - Potassium channel blockers:
- Amiodarone, dronedarone, propafenone, sotalol (also in class 2)

Class 4 - Non-dihydropyridine calcium channel blockers:
- Diltiazem, verapamil

40
Q

When can paternal anticoagulation be given?

A

Heparin can be offered to patients with new acute onset of AF, who are not taking any anticoagulants.

This should be done until an assessment is made and an appropriate anticoagulant is started.

41
Q

What oral anticoagulants can be given in AF?

A

NOACs are recommended as first line treatment.
If contra-indicated, give warfarin.

Oral anticoagulants are given to all pts with confirmed AF

42
Q

What assessment is used to calculate stroke risk in arrhythmias?

A

CHADSVasc

43
Q

What assessment is used to calculate bleeding risk in arrhythmias?

A

ORBIT

44
Q

What are the factors of CHADSVasc?
And what does the result mean?

A

Congestive Heart Failure – 1
Hypertension – 1
Age – 1 (>65) or 2 (>75)
Diabetes – 1
Stroke – 1
Vascular Disease – 1
Female – 1

Results:
Requires anticoagulation if males = >0 or females = >1

45
Q

What are the factors of ORBIT?
And what does the result mean?

A

Older than 74 – 1
Reduced Haemoglobin – 2
Bleeding History – 2
Inadequate Renal Function – 1
Treatment with Antiplatelets – 1

Results:
0-2 – Low risk of bleeding
3 – Medium risk of bleeding
4-7 – High risk of bleeding

46
Q
A

Cardiovascular System (8 decks)

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