Conduction disorders Flashcards
What are indications for hospitalization of afib?
Active ischemia
Heart failure
Hypotension
Difficult rate control
Evidence of organ hypoperfusion
(confusion, renal injury)
What are indications for rhythm control in a fib?
Hemodynamic instability
Failure of rate control
First episode
Young patient
CHF
Reversible cause
What score dictates the need for anticoagulation therapy in a fib?
CHA2DS2VASC criteria - >2 in men or >3 in women
CHA2DS2-VASc criteria
CHF
HTN
Age>75 (2)
DM
Stroke, TIA, thrombus (2)
Vascular disease
Age 65-74
Sex (female)
total of 9
What are the three steps to consider maintenance of afib?
1) rate control (1st line for minimal w/ no symptoms) w/ BBs or CCBs
2) reversion + return to sinus rhythm w/ cardioversion if new onset or if remains symptomatic
3) a fib –> anticoagulation therapy
What is the ultimate backup rate control drug for A fib?
amiodarone
Consider after beta blockers, ca channel blockers, and digoxin
What a fib rate control drug do you use in HF?
digoxin
Can you use BBs in lung disease?
no
Warfarin is for anyone with ____
mechanical valves, mitral disease (because commonly w A fib), ventricular assist devices
Why are DOACs preferred in A fib compared to warfarin?
no monitoring necessary
How do you treat a fib>48 hours with unkown cause?
3 weeks of anticoagulation before cardioversion OR rule out thrombus with TEE and then 4 weeks of anticoagulation after cardioversion
Who needs aspirin treatment in a fib?
everyone except CHD or peripheral vascular disease
How do you treat an unstable a fib patient?
IV heparin + IV rate control (beta blocker, CCB) + cardioversion (120-200 joules)
How do you treat a flutter?
rate control w/ BBs or non di-CCBS
cardioversion 50-100 joules
atrial flutter ablation can be used to prevent coagulation therapy
Can you use pharmacological cardioversion in atrial flutter?
no not recommended
How do you treat MAT?
oxygen, treatment of underlying condition, and rate control –
preserved LV function: BBs, non-di CCBs, digoxin, adenosine, IV flecainide, IV propafenone
non-LV: digoxin, diltiazem amiodarone
How do you treat sinus tach?
underlying disease
BB for inappropriate sinus tach
How do you treat sinus brady?
atropine if symptomatic, repeated every 3-5 min up to 3 mg
How do you treat sick sinus syndrome?
identify and correct factors (could be anything), symptom control, permanent pacemaker placement
symptomatic = permanent pacemaker w/ dual chamber pacing + atropine
With bradycardia + alternating ventricular tachycardia = permanent pacemaker with automatic implantable cardioverter-defibrillator (AICD)
How do you treat a second degree Type I block?
asymptomatic = observation
symptomatic = atropine, epi w/ or w/o pacemaker
How do you treat a second degree Type II block?
Symptomatic = atropine, pacing
Permanent pacemaker
How do you treat a third degree block?
Temporary pacing, permanent pacemaker, atropine for bradycardia
How do you treat PACs?
none if asymptomatic
if symptomatic, beta blockers, and stopping precipitating factors
How do you treat PVCs
asymptomatic = no tx
treat underlying cause, remove precipitating factors
symptomatic or with high PVC burden in patient w/ CHF = beta blockers
High PVCs in CHF = catheter ablation
