Arrythmias Flashcards
(31 cards)
Sinus rhythm can be restored by pharmacological cardioversion using what drugs?
Amiodarine or flecanide oral or IV
If atrial fibrillation is present for more than 48 hour which type of cardioversion (electrical or pharmacological) is recommended?
Electrical
Which beta blocker is not recommended in ventricular control?
Sotalol, can occasionally cause life threatening ventricular arrythmia and may prolong QT interval
What CCBS can be used for rate limiting ventricular control?
Dilitazem and verapamil
Dividing monotherapy is usually seen in elderly patients, why is this?
Usually only effective for controlling ventricular rate at rest so only used as monotherapy in predominantly sedentary patients with paroxysmal AF
Combination therapy may be required if pts aren’t adequately controlled, what combination of drugs favours pts whose ventricular function has diminished?
Beta blocker and digoxin
What drug is recommended when AF is accompanied by congestive HF?
Digoxin
What treatment is recommended in maintaining sinus rhythm post cardioversion?
Standard beta blocker, also used for ventricular rythm control in paroxysmal AF
What s the pill in the pocket concept?
A patient with paroxysmal AF experiences episodes of AF with symptoms which can last up to 7 days, a pill in the pocket is used to self treat when an episode occurs and is usually given oral flecanide or propafenone.
What risk tools are used to identify the risks and benefits of stroke prevention in AF pts?
CHA2DS2VASc- CHF or LVEF, HT, Age>75, Diabetes, Prior stroke/TIA/thromboemobolism, vascular disease, Age, Sex
HAS-BLED, HT, renal function, prior stroke, prior bleeding, Labile INR, Elderly (+65), Drugs with bleeding risk
Anticoagulation treatment should not be withheld solely due to risks of falls!
.
Can aspirin monotherapy be used in stroke prevention?
No , it is less effective than warfarin and its benefits are offset by risk of bleeding
Tx for atrial flutter are very similar for AF using drugs to control ventricular rate or sinus rhythm, in terms of success rate which condition is easier to manage?
AF. Atrial fibrillation responds less well to drug treatment
What type of arythmia is a medical emergency? Atrial flutter Supraventricular Tachycardia Atrial fibrillation Ventricular Tachycardia
Ventricular Tachycardia
What type of arrhythmia is associated with a long QT syndrome?
Torsade de Pointes
Anti-arrhythmic drugs can be classedin 2 ways, the Vaughan Williams classification and those that act on arrhythmic types
Vaughan Williams classification uses class numbers which has less clinical significance. The other classification determins its uses, Verapamil acts on supraventricular, amiodarone both supra and ventricular, lidocaine acts on ventricular
Arrhythmic drugs have negative ionotropic effects which tends to be additive.
If a combination of anti-arrhythmic drugs are used care should be taken especially if myocardial function is impaired
Disopyramide is a useful antiarrhythmic which can be administered iv or oral, however it has antimuscarinic effects which may make it unsuitable in what conditions?
Angle-closure glaucoma
Prostate hyperplasia
Cardiac glycosides and verapamil are useful for what type of arrhythmias?
Supraventricular
Iidocaine HCl is useful for which type of arrhythmias?
Ventricular
Amiodarone, beta blockers, disopyramide, flecanide, procainamide and propafenone are useful in what type of arrhythmias?
Both supraventricular and ventricular
What can be given as treatment for life threatening digoxin toxicity?
Withdraw digoxin, treat clinical manifestations, Digoxin specific antibodies are available.
What is iv digoxin not recommended for persistent tachycardia?
Response may take mtany hours
What organ system plays the most important factor in determining digoxin dose?
Renal function
