Chapter 2: Cardiovascular System Flashcards Preview

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Flashcards in Chapter 2: Cardiovascular System Deck (381)
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Is treatment usually required for ectopic beats?

No, but can use beta blockers if needed


What two things can you try and control in a patient with AF?

Rate and rhythm control


In patients without life-threatening haemodynamic instability, if a patient has onset of AF less than 48 hours ago, what can be offered to the patient?

A- rate control
B- rhythm control
C- both
C- both


If a patient presents with AF and the onset is more than 48 hours ago or uncertain, is it preferable to control rate or rhythm?



What beta blocker should you not use in rate control for AF?



1. How can ventricular rate be controlled in AF?

2. If this does not work, what can be used?

1. Monotherapy:

Standard beta blocker (not sotalol)
Rate limiting CCB e.g. verapamil
Diltiazem is used but unlicensed

2. Combination of beta blocker, digoxin or diltiazem


What group of patients should digoxin monotherapy be used for ventricular control in AF?

Only effective for controlling the ventricular rate at rest, so should only be used as monotherapy in sednetary (inactive) patients with non-paroxysmal atrial fibrillation.


What is meant by paroxysmal AF?

Episodes come and go


If dual ventricular rate therapy does not control symptoms in AF, what can then be considered?

Rhythm control


In patients with AF and diminished ventricular function, what should be used to control rate?

Beta blockers that are licensed for use in heart failure and digoxin


Post cardioversion in AF, what is used to maintain sinus rhythm?

Beta blocker


What is 1st line for long term rhythm control in AF?

Beta blocker (not sotalol)


If amiodarone is needed in an electrical cardioversion patient, how long before and after the procedure can they be on it for?

4 weeks before and up to 12 months after


For rhythm control in AF, when what group of patients would flecainide acetetate or propafenone NOT be suitable for?

Known ischaemic or structural heart disease


When would dronedarone be used in rhythm control for AF?

As an option for the maintenance of sinus rhythm after successful cardioversion in people with paroxysmal or persistent atrial fibrillation:
- whose atrial fibrillation is not controlled by first line therapy (usually including beta blockers), that is, as a second line treatment option and after alternative options have been considered and who have at least 1 of the following cardiovascular risk factors:
-hypertension requiring drugs of at least 2 different classes
- diabetes mellitus
- previous transient ischaemic attack, stroke or systemic embolism
- left atrial diameter of 50 mm or greater or
- age 70 years or older and

who do not have left ventricular systolic dysfunction and
who do not have a history of, or current, heart failure.
(consider amiodarone in these patients)


What group of patients would you consider amiodarone for in rhythm control for AF?

Left ventricular impairment or heart failure


What 2 drugs can be used for the "pill in the pocket" approach for AF?

Flecainide or propafenone


What tool do you use to assess for stroke risk in AF patients?



What tool do you use to assess for bleeding risk?



At what CHADVASC score in men would you consider anticoagulation in AF?

At what score should you offer (taking into account bleeding risk)?




At what CHADVASC score in females would you consider anticoagulation to in AF?



Is aspirin monotherapy recommended for stroke prevention in AF?



What is the MHRA warning associated with amiodarone and hepatitis C antivirals?

Increased risk of bradycardia and heart block
Needs very close monitoring if used together but ideally use alternatives


What are the key side effects of amiodarone?

1. Corneal microdeposits (reversible upon withdrawal of treatment but can cause blindness)

2. Thyroid function- amiodarone contains iodine and can cause hyper and hypothyroidism (thyrotoxicosis)

3. Hepatotoxicity

4. Pulmonary toxicity- pneumonitis should always be suspected is new or worsening SOB occurs

5. "Dazzled in light" phototoxicity

6. Grey skin discolouration

7. Altered taste

8. Sleep disorders

9. Peripheral neuropathy


What does amiodarone contain that could cause thryoid problems?



What is the patient advice regarding amiodarone and the sun?

Patients should be instructed to avoid exposure to sun and to use protective measures during therapy as patients taking Amiodarone tablets can become unduly sensitive to sunlight, which may persist after several months of discontinuation of Amiodarone tablets. In most cases symptoms are limited to tingling, burning and erythema of sun-exposed skin but severe phototoxic reactions with blistering may be seen.

Patients need to shield their skin from light during treatment and for several months after discontinuing treatment as it has a very long half life


What is the main side effects with dronedarone?

Can cause/worsen heart failure so patients should seek help if symptoms of SOB, oedema, weight gain

Hepatic failure - Seek prompt medical attention if symptoms such as abdominal pain, anorexia, nausea, vomiting, fever occur

Pulmonary toxicity


What is the important safety information regarding sotalol and what it should be used for?

QT prolongation
Need to correct any hypokalaemia before starting

The use of sotalol should be limited to the treatment of ventricular arrhythmias or
prophylaxis of supraventricular arrhythmias. It should no longer be used for angina, hypertension,
thyrotoxicosis or for secondary prevention after myocardial infaction


If digoxin is being used alongside amiodarone, dronedarone or quinine, what do you do to the dose of digoxin?

Half it


When switching from IV to oral digoxin, how should you convert the dose?

Increase by 20-33%