Arrhythmia Treatment Flashcards
what is the treatment for sinus bradycardia?
atropine (if acute, e.g. mi)
pacing if haemodynamic compromise (hypotension, CHF, angina, collapse)
what is a drug class that can cause sinus bradycardia?
Beta blockers
what is the treatment for sinus tachycardia?
Beta- adrenergic blockers
treat underlying cause
what is the treatment for atrial ectopic beats?
there is generally no treatment
B- adrenergic blockers can help
avoid stimulants (caffeine, cigarettes)
what is the acute management of supraventricular tachycardia?
vagal manoeuvres: Valsalva manoeuvre, carotid sinus massage
IV adenosine (verapamil is an alternative)
what is used to treat acute stable SVT patients in which vagal/ drug treatments have failed?
DDCV - direct current cardioversion
which drugs are used in acute SVT?
IV adenosine
IV verapamil
how does adenosine work?
slows cardiac conduction primarily through AV node
It interrupts the AV node / accessory pathway during SVT and ‘resets’ it back to sinus rhythm
what is the first line treatment in chronic SVT management for the young/symptomatic patients?
electrophysiological study
radiofrequency ablation
what are chronic managements of SVT?
avoid stimulants
Beta Blockers
Antiarrhythmic drugs
Electrophysiologic study and Radiofrequency ablation (first line in young, symptomatic patients)
what is long term management of patients with paroxysmal SVT?
medication- beta blockers, CCB or amiodarone
radiofrequency ablation- preferred in younger patients
what is the treatment for atrioventricular block?
pacemaker
how is unstable VT with a pulse managed?
DDCV (direct current cardioversion)
how is pulseless VT managed?
defibrillation
how is stable ventricular tachycardia managed?
First line: anti-arrhythmic drugs : amiodarone or lignocaine
DDCV if medical treatment fails
what is given for stable VT if medical treatment fails?
DDCV
if you are unsure if it is VT or something else, what should be used to make a diagnosis?
adenosine
because adenosine should not have effect on ventricular arrhythmias
which anti arrhythmic drugs should be used for VT?
Anti-arrhythmic drugs to date have been shown to be ineffective and are associated with worse outcomes
what is long term treatment for ventricular tachycardia?
correct ischaemia if possible- revascularisation
if life threatening: ICD- implantable cardioverter defibrillator
VT catheter ablation
can both VT and VF be defibrillated?
yes
Defibrillation or unsynchronized cardioversion is indicated in any patient with pulseless VT/VF or unstable polymorphic VT, where synchronized cardioversion is not possible
what is the management for VF?
defibrillation
cardiopulmonary resuscitation
long term- ICD
what is long term VT treatment?
ICD- implantable cardioverter-defibrillator
if AF is causing heart failure should B-blockers be used?
no
what are options for rate control in AF?
- β-blocker e.g. atenolol is first line
- CCB e.g. diltiazem (not preferable in heart failure), verapamil (NOT OTHER CCBs)
- Digoxin (increases vagal tone) (only in sedentary people, needs monitoring and risk of toxicity)
alone or cautiously in combination
- Other: AV node ablation
