Arrhythmia

Question 1

If a patient has AF, what should they be tested for and might be given?

Answer 1

Risk of stroke and thromboembolism

thromboprophylaxis

Question 2

What is ventricular rate?

Which drugs control ventricular rate?

Answer 2

Verapamil or beta-blockers

Question 3

What is sinus rhythm and how is this controlled?

Answer 3

Flecanide (Class 1) or amiodarone (all four classes of action)

Question 4

Which drugs act on supraventricular arrhythmia’s?

Answer 4

Verapamil (can be used in asthmatics)
Adenosine
cardiac glycosides

Question 5

Which two drugs should not be used together?

Answer 5

Verapamil and BB’s

Question 6

Which drugs act on supraventricular AND ventricular arrhythmia’s?

Answer 6

Sotalol, amiodarone, BB’s (sotalol), flecanide

Question 7

Which drugs act on ventricular arrhythmias?

Answer 7

Lidocaine (usually used in emergency situations)

Question 8

What are ectopic beats? How is this treated?

Answer 8

irregular heart rhythm.
If pt has a normal heart rate, no tx required, only reassurance to the pt is necessary.

However, BB can be given and are safer

Question 9

what are the aims of tx for pts with AF?

Answer 9

• reduce symptoms

- prevent complications especially stroke

Question 10

How is AF managed?
What tx is preferred?
If not managed, what tx is necessary?

Answer 10

1. Rate control (ventricular rate) - preferred except in patients with:
   - new onset of AF
   - HF secondary to AF
   - Atrial Flutter suitable for ablation therapy
   - AF with a reversible cause
   - if rhythm control is more suitable
2. Rhythm control (maintain sinus rhythm)

if this fails or symptoms are not controlled - cardioversion is required within 4 weeks or ablation.

Question 11

if AF is presenting with or without life-threatening with haemodyamic instability, what tx should the pt undergo?

Answer 11

WITH: Emergency electrical cardioversion
WITHOUT: rate or rhythm control if the onset of arrhythmia is less than 48 hours
if more than 48 hours, rate control should be used

Question 12

What is given for pharmacological cardioversion?

Answer 12

IV amiodarone hydrochloride
or flecanide
and OAC given for at least 4 weeks after cardioversion

Question 13

How is ventricular rate controlled?

if a single drug is not adequate for treatment

Answer 13

BB (not sotalol)
OR
rate-limiting CCB (diltiazem or verapamil monotherapy)

Digoxin (used as monotherapy) - usually in sedentary pts with non-paroxysmal AF

Question 14

What is choice of tx based on?

Answer 14

co-morbidities
patient preference
heart rate
individual symptoms