Arrhythmias Flashcards
(33 cards)
Plan for acute AF with life threatening haemodynamic instability
Emergency electrical cardioversion
Can use flecainide or amiodarone
Amiodarone for people with structural heart disease
Plan for acute AF without life threatening haemodynamic instability
Onset AF <48hrs rate or rhythm control
Onset AF >48hrs rate control
Can use flecainide or amiodarone
Amiodarone for people with structural heart disease
What is 2nd line rate conteol monotherapy
Rate limiting CCB - diltiazem or verapamil
What is 1st line for rate control monotherpy
Standard BB not sotalol
What is 3rd line for rate control monotherapy
Digoxin only effective for ventricular rate at rest
Non paroxysmal AF and does minimal excercise
What is not recommended for long term rate control
Amiodarone
Should be used for rhythm
What is treatment plan for rate control dual therapy
BB with diltiazem or digoxin
This combo is C/I in HF not AF
What is 1st line rhythm control
Beta blocker
What is 2nd line rhythm control
Dronedarone
Amiodarone
If AF has persisted over 48 hrs what is plan
Electrical cardioversion
Consider amiodarone 4 weeks before and 12 months after to maintain sinus rhythm
Delay cardioversion until maintained on anticiagulation for minimum 3 weeks
Drug treatment plan after cardioversion
Amiodarone 12 months
Anticoagulant for atleast 4 weeks
Standard BB
if not use SPAF
Sotalol, propefenone, amiodarone, flecainide
What is CHADSVASC used to assess
Risk estimation for stroke or other thrombolic events
What is the CHADSVASC scoring
Who requires anticoag
Congestive HF
Hypertension
Age 75+ 2 POINTS
Diabetes
Stroke/TIA 2 POINTS
Vascular disease
Age 65-74
Sex female
Anticoag for males with 1+ and females with 2+
What does ORBIT assess
Identify people at high risk of bleeding
Paroxysmal AF 1st and 2nd line
Standard BB
if uncontrolled SPAF
sotalol, propafenone, amiodarone, flecainide
what is the ORBIT scoring
Over 75 years
Reduced haemoglobin 2 POINTS
Bleeding history 2 POINTS
Insufficient kidney function
Treatment with antiplatelet
What is low medium high risk of ORBIT scoring
Low 0-2
Medium 3
High 4-7
Paroxysmal supraventricular tachycardia management plan
- Reflex vagal stimulation - immerse face in ice cold water with ECG monitoring
- IV adenosine
- IV verapamil
Paroxysmal AF pt has episodes what is the management plan
Pill in the pocket
Oral flecainide or propafene PRN
Atrial flutter must be on what drug before cardioversion
Anticoagulant for 3 weeks prior
If flutter has lasted more than 48hrs
Plan for unstable sustained ventricular tachycardia
Direct current cardioversion then
IV amiodarone then
Repeat current cardioversion
Plan for pts with high risk of cardiac arrest
Maintenance therapy
Implantable cardioverter defibrillator
Add BB/amiodarone
Plan for stable venteicular tachycardia
Sustained and nonsustained
IV amiodarone then
Direct current cardioversion
Non sustained then BB
Torsade de pointes - what exacerbates this
QT prolongation
Caused by HYPOkalaemia or severe bradycardia
Amiodarone, sotalol, macrolides, haloperidol, SSRIs, TCAs, antifungals
