Afibrilation Flashcards
Rhytm control strategy
converting Afib back to normal sinus rhythm
- via Electrical or pharmacological
- Pharmacological : flecande, dofeltide, propafenone, ibultide, amidorane
if abif <48 hours : start anticoag & cardioversion
if afib>48h
- if clot: anticoag
- if no clot: cardiover same day and anticoagulant
Rate control strategy
- blocking some of arterial electrical imuplse at AV node before they reach ventricles by AV blocker
1st line: BB or Non DHP CCb
AV blocker
- bradycardia, hypotension
A: amiodorane
B: BB
C: CCB (Non DHP)
D: Digoxin
AFib flutter managment
- Rhytm control
- Rate control
- clot control
Clot control
by anticoagulant. Approved anticoagulant for Afib
- Warfarin (VKA)
- Dabigatroban (Pradaxa)
- Apixaban (Eliquis)
- Rivaroxaban (Xarelto)
- Edoxaban (Savaysa)
war pref for pt with valvular hear dx or mechanical heart valve
ASsesing risk of stroke in AFib
CHA2DS2- VAS
C: CHF- 1pt
H: HTN- 1 pt
A: Age > 75 - 2pt
DM: 1pt
Stroke/TIA: - 2 pt
V: Vascular Dx- 1pt
A: Age 65-74 - 1pt
S: Sex: Fem-1 pt
Afib Anticoagulation guideline
chest 2018 Afib guideline
- atleast 1 non sex risk factor
AHA/ACC 2019 Afib guideline
- atleast 2 non-sex risk factor
warfarin pref for
LMWH
- valvular heart dx or mechanical heart valve
- recommend for ESRD
LMWH pref of pregnant pt.
for preg pt use LMWH
phases of A.potential
phase 0: depolarizaiton; Na entry
- Na+ channel work her
Phase 2: plateau phase: ca+ chan works here
Phase 3: Repolarizaiton: k+chanel works
- IASDD — amiodorane works her
Phase 4: BB
Class I a (QDP)
class I b (LM)
class 1c (FP)
doubel quarter pounder
-quinidine
-Procainamide (Pronestyl)
- Disopyranimide (norpace)
Lettuce and mayo
- Lidocaine (Xylocaine )
- Mexilitene
Fries please
- Flecanide (Tambocor)
- Propafenon (Rhytmol)
Quinidine
Q: Quinidine
- SE: diarhea, QT, Cinchonnism, thrombocytopenia , hemolytic anemia
Disopyramide
Norpace
Side Effect
- Anticholinergic
- neg ionotorpic (don’t give to pt with CHF), hypotension
- torsade
- indication: Ventricular arrythmia
Procainamide
used for ventricular arrythmia
- ANA+ ( lupus)
- hypotension
- bradycardia
- Diarhea
class i b
Lidocaine
Mexilitene
IV Xylocaine
- light headed
- seizure
- Dilute in d5w
Mexiltene: PO
Class I c
- flecandie
- Propafenone
flecanide ( Tambocor)
- arrythmia, lighthead, torsade
Propafenon ( Rhytmol)
-neg ionotrope
- BB activity
- seizure
class II b
BB
- RAte control in Afib
IV BB: Maples
- metoprol
- atenolol
- propanolol (inderall)
- labetaol
- esmolol (breviloc)
- sotalol
Antidoe: Glucagon
if pt has arrythmia and HF best BB
bismolol (zebeta)
Metoprolol succinate (Toprol xL)
carvedilol (coreg)
Class III “IASDD”
- Ibutilide (corver)
- Amiodorane (Nexterone, pacerone)
- Sotalol (betapce)
- Dronaderone (multaq)
- Dofeltide (Tikosyn)
Ibutilide
- corvet
- for acute arrythmia
- SE: fatal arrythmia
Amiodorane
Pacerone tablets
Nexterone premixed Inj
indication: ventricular arrythmia & Afib
SE:
- photosenistiviy
- pulmonary toxicity
- corneal micro deposit
- thyroid dysfunction
- smurfig
- inc QT
- LFT
- CNS
- Hypotension, Bradycardia
amiodorane monitor
- TSH
- LFT
- eyes
- chest
- Pulmonary fxn
- ECG (HR)
- Electrolyte: Low K and Mg cause arrythmia
- ## amiodorane long half life 30-60 days
amiodorane DUR
- inc digoxine level by 70%
- cyp3A4 substrated and inhib
- warfarin and digoxine dose reduced by 30-50% when starting amiodorane
- Sofosbuvir may inc bradycardia effect. AVoid combination - Harvoni ( Ledipasvir + sofosbuvir)
- quinolone, macrolide and azole cause QT prolongation
amiodorane store and stabiltiy
for infusion >2hr use non-pvc bag or glass
- use 0.22 mciron filter
-
amiodorane
a: alveoli (CXR) & AV blocker (bradycardia)
iod: TSH
o: corneal deposit & photosensitivy
E: electrolyte monitor (low K, Mg), ECG
N: non pvc bag if inf>2hr and 0.22 micron
D: DUR ( inc dig level, warfarin levels so decr dig and warfarin by 30-50%, avoid sofosbuvir- including Harvoni, cyp3a4 subrate and inhibitor)
- monitor LFT
Blue man
Dronaderone
Maltaq
- used for Afib
- Dose : 400mg BID with food
- SE: Liver failure/ HF
- CYP3A4 subrstrate/Inhib
sotalol
betapace, Betapace AF
do not subsitiute one for another
Dofelitide
Tikosyn
verapmil
Calan, Verelan
PSVT
paroxysmal supraventricular Tachycardia
Adenosine (Adenocard)
- used for PSVT (paroxysmal supraventricular Tachycardia)
if adenosine fails to convert to SVT
then use
- BB or
- NON DHP CCB
VF/ pulseless (Ventricular fibrilation) TX
- CPR–shock (defibrilate)—-Epinephrine—shock —-amiod or Lidocaine
- ephinephrine 1mg Q3-5min
- Amiodorane
PUlseless electrical activity or Asystole (flat line)
-Epi is DOC for PEA of asystole
Symptomatic bradycardia
DOC: Atropine IV
if atropine ineffective then
- Dopamine
- Epinephrine
