Arrhythmia Flashcards
What are the different types of arrhythmias?
- Atrial Fibrillation
- Paroxysmal Supraventricular Arrhythmias
- Ventricular Arrhythmias
What are the different anti- arrhythmias medications?
Class I - Membrane Stabilising drug; Na+ Blockers e.g. Disopyramide, Lidocaine, Flecainide/Propafenone
Class II - Beta Blockers e.g. Propanolol, Esmolol etc.
Class III - K+ Channel Blockers e.g. Amiodarone, Sotalol, Dronedarone
Class IV - Calcium Channel Blocker (rate-liming) e.g. Verapamil, Diltiazem (unlicensed)
Other - Digoxin and Adenosine
What is Atrial Fibrillation?
The firing of abnormal and disorganised electrical signals causing the atria to quiver and fibrillate = rapid and irregular heartbeat.
The ventricular rate of untreated AF often averages between 160–180 beats per minute (although this is typically slower in older people).
What are the two main ways to try and treat Atrial Fibrillation?
- Ventricular Rate (rate control)
2. Restoring and Maintaining Sinus rhythm (rhythm control)
What are the symptoms of Atrial Fibrillation?
- Heart Palpitations - Pounding/ Fluttering
- Dizziness, SOB, Tiredness
What are the complications of AF?
Stroke and Heart Failure
What are the three types of AF
- Paroxysmal AF - Episodes resolve without treatment within 48 hours
- Persistent AF - Episode last > 7 days
- Permanent AF - present all the time
How do you restore sinus rhythm control?
Cardioversion - two types ( 1. Electrical and 2. Pharmacological)
Do not give if symptoms are > 48 hours due to increase risk of stroke.
Electrical is preferred if symotoms are > 48hours.
Wait unitl patient is fully anticoagulated for 3 weeks before cardiversion and continue for 4 weeks after.
What to do if a patient is life-threatening haemodynamically unstable in an ACUTE NEW ONSET PRESENTATION?
Treat with electrical cardioversion- give parenteral anticoagulant first and rule out atrial thrombus before the procedure
What to do if a patient is NON- life-threatening haemodynamically unstable in an ACUTE NEW ONSET PRESENTATION?
< 48 hours = rate/ rhythm control - Amiodarone/ Flecainide or Electrical cardioversion.
N.B. Amiodarone would be preferred over Flecainind if patient had structural/ ischaemic heart disease
> 48 hour = rate control - Beta Blocker (not sotalol) or Verapamil
What is maintenance drug treatment for AF?
1st line = Rate Control - Beta Blocker (not sotalol) or rate limiting CCB or Digoxin
2nd Line = Rhythm control - Sotalol, Amiodarone, Dronedarone, Flecainide Proafenone
What anti-arrhythmia medications are contraindicated in asthma, and severe COPD and should be avoided in structural/ischaemic heart disease?
Flecainide and Propafenone
What medication should be started 4 weeks before an electrical cardioversion and to continue 12 months after?
Amiodarone
What medication has the side effects of hepatotoxicity and heart failure?
Dronedarone
What medication is effective as a monotherapy in sedentary patients that present with non- paroxysmal atrial fibrillation or patients with congestive heart failure?
Digoxin - only works to control ventricular rate at rest
