Arrhythmias 1 : Atrial fibrillation Flashcards
1) What is an Ectopic beat?
2) What are the treatment options?
1) Irregular heart rhythm due to a premature heartbeat
2) If beats are spontaneous and patient has normal heart rate, treatment rarely required- reassure patient
↳ If troublesome give B-blockers
What should all patients at risk of atrial fibrillation (AF) be assessed for? (2)
1) Risk of stroke
2) Risk of thromboembolism
List the two ways AF be managed?
1) Ventricular rate control
2) Restoring sinus rhythm (rhythm control)
↳if treatment fails at any stage or symptoms reappear referral should be made within 4 weeks
What should be reviewed annually in all AF patients? (3)
1) Anticoagulation
2) Stroke
3) Bleeding risk
What is the treatment option for patients presenting with life-threatening haemodynamic instability caused by new onset AF
Emergency electrical cardioversion to achieve anticoagulation
What is the treatment option for patients presenting with acute AF without life threatening haemodynamic instability if the:
1) onset of arrhythmia is ˂ 48h
2) onset of arrhythmia is ˃48h
1) Rate or rhythm control can be offered if onset ˂ 48h
2) Rate preferred if onset ˃48h or uncertain
1) What is cardioversion?
2) when should electrical cardioversion be used rather than pharmacological cardioversion?
1) Medical procedure by which an abnormally fast heart rate or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs (rhythm control)
2) If AF that has persisted for > 48 hours, electrical cardioversion is used
Which drugs are used to treat an acute presentation of AF if pharmacological cardioversion is used?
IV amiodarone or alternatively flecainide acetate. ↳Amiodarone preferred if there is structural heart disease
2) if urgent rate control required IV B-blocker or Verapamil
1) If AF has been present for more than 48h what type of cardioversion is preferred?
2) Cardioversion should not be attempted until the patient has been anti-coagulated for how many weeks?
1) Electrical cardioversion preferred
2) Do not attempt unless patient has been anti-coagulated for at least 3 weeeks.
3) parenteral anticoagulation should be commenced, and a left atrial thrombus ruled out immediately before cardioversion
Cardioversion should not be attempted until the patient has been anti-coagulated for at least 3 weeks. What if this is not possible?
parenteral anticoagulation should be commenced, and a left atrial thrombus ruled out immediately before cardioversion
Oral anticoagulation should be given after cardioversion and continued for how many weeks?
At least 4 weeks
↳(prior to cardioversion, offer rate control)
Rate control is the preferred first-line drug treatment strategy for atrial fibrillation, except in which patients ?
1) New-onset AF
2) Atrial flutter suitable for an ablation strategy
3) AF with a reversible cause
↳Refer to a cardiologist for consideration of rhythm-control treatment (cardioversion)
Rate control is the preferred first-line drug treatment strategy for most people with atrial fibrillation. Outline the drugs are used to control ventricular rate?
1) Standard B-blocker (not sotalol) or rate limiting CCB such as diltiazem or verapimil as monotherapy
2) Digoxin only effective for controlling the ventricular rate at rest, so only used as monotherapy in predominantly sedentary patients with non-paroxysmal atrial fibrillation.
A B-blocker or a rate-limiting CCB are both first line rate control options in AF. With regards to the patient, what does the choice between these two drugs depend on?
1) Co-morbidities
↳ B-blockers : C/I in asthma
↳Rate-limiting CCBs are C/I in people with co-existing heart failure
1) What drugs can be given if a single agent fails to control ventricular rate?
2) what if this is still not adequate?
1) A combination of 2 drugs including a B-blocker, digoxin or diltiazem can be used.
2) If symptoms still not controlled with 2 drugs a rhythm-control strategy should be considered
