Arrhythmias Flashcards
what are ectopic beats
electrical hearts beats are spontaneous heart beats that come out outside the normal electrical nodes. This causes an extra heart beat
note patients can still have a normal heart beat and have these occur
what are arrhythmias
irregular heart beat
what should you do if a patient has an ectopic beat but still has a normal heart beat
- no treatment needed. just reassure patient
what should you do if a patient has an ectopic beat but the symptoms are troublesome
can give the patient a beta blockers
e.g bisoprolol, atenolol, propranolol
what are the 2 aims of treatment for atrial fibrillation (AF)
- reduce symptoms
- prevent complications (most common complication= stroke)
what do you need to assess in all patients with atrial fibrillation (AF)
Assess:
- risk of stroke and thromboembolism (balanced with risk of bleeding)
note: when you have AF, the irregular heart beat can leave residual blood in the heart which can form a blood clot, if blood clot moves away into brain (through pumping of blood) this causes a stroke
what are the 2 types of drug treatment to manage atrial fibrillation (AF)
- control ventricular rate (rate control)
- restore and maintain sinus rhythm (rhythm control) through meds + cardioversion
- e.g through cardioversion (using electrical pads, to send synchronized electricity to get the heart beat back to normal)*
what is sinus rhythm
the normal rhythm of the heart
(normal heart rhythm made up of: a normal heart rate between 60-100 BPM, electrical signal starts from the SAN node, electrical impulse follows normal path of the heart + electrical impulse moves at normal speed)
which drugs are used in RATE control treatment for atrial fibrillation
- beta blockers (not sotalol) most commonly used
- rate-limiting CCB: verapamil (common) + diltiazem (unlicensed)
which beta blocker is NOT used for rate control treatment in atrial fibrillation
sotalol
which drugs are used in RHYTHM control after cardioversion in atrial fibrillation
- first line = beta blockers (can use sotalol)
if beta blockers fail, then can use:
- flecainide
- amiodarone
which type of atrial fibrillation treatment can we use sotalol
sotalol can be used in rhythm control
‘(but NOT IN RATE CONTROL)
how do you assess a patient’s risk of stroke and risk of bleeding
- risk of stroke: use CHAD2DS2-VASC tool (looks at patients risk of cardiovascular disease)
- risk of bleeding: use HAS-BLED tool
what should you do if a patient has a low risk of stroke after using the CHA2DS2-VASC tool
give the figures which mean low risk
low risk CHADS score is: men = 0 and women = 1
if they have this low risk score, the patient doesn’t need any treatment to prevent stroke (no thromboprophylaxis)
which drug is class 2 and class 3 on the vaughan williams classification
sotalol
describe the classes for anti-arrhythmic drugs based on the vaughan williams classification
Class I: membrane stabilising drugs (e.g. lidocaine, flecainide)
Class II: beta-blockers
Class III: amiodarone; sotalol (also Class II)
Class IV: rate-limiting calcium-channel blockers (includes verapamil but not dihydropyridines)
which drugs are used to treat supraventricular arrhythmias
- adenosine (first line choice because it has a short half life of 8-10 secs. so has short-lived side effects + can be used in combination with beta blockers)
- verapamil
- cardiac glycosides (e.g digoxin)
which drugs are used to treat ventricular arrhythmias
- lidocaine
- sotalol
which drugs can be used to treat both supraventricular + ventricular arrhythmias
- amiodarone (first line choice. can be I.V or oral but should be started in hospital/ under specialist supervision)
- beta blockers
which drug class must NOT be combined with verapamil
beta blockers (because they interact and cause side effects)
what is an advantage of using amiodarone to treat supraventricular + ventricular arrhythmias
it causes little/ no myocardial depression
why might amiodarone still cause interactions with other drugs even if a patient has stopped taking it
because amiodarone has a very long half life (weeks/months) so amiodarone can still be present in the body weeks/months after the patient has stopped taking it
which cardiac glycoside can be used in a patient who has both atrial fibrillation (AF) and chronic heart failure (CHF)
digoxin
what is atrial fibrillation
a rapid and irregular heart beat
which drugs are used for EMERGENCY RATE control in patient with acute presentations of atrial fibrillation
use I.V verapamil or I.V beta blocker
which drugs are used for EMERGENCY RHYTHM control in patients with acute presentations of atrial fibrillation
use I.V amiodarone or I.V flecainide
what are the 2 types of cardioversion
- electrical
- pharmacological (with amiodarone or flecainide which can be given I.V or oral)
what is cardioversion
when an abnormally fast heart rate or cardiac arrhythmia is converted back to sinus rhythm (normal heart rhythm)
what should you do for 3 weeks before attempting electrical cardioversion
make sure the patient is fully anticoagulated
procedure carries an increased risk of thromboembolism
what is paroxysmal atrial fibrillation
what is the treatment
atrial fibrillation (rapid + irregular heartbeat) that comes and goes (paroxysmal).
- it usually stops on its own within 48 hours
- can use a standard beta blocker to treat symptoms. (if beta-blocker not tolerated, use other anti-arrhythmias e.g amiodarone/flecainide/ sotalol)
what is the “pill-in-pocket” approach and when is it used
when patients with infrequent (random) episodes of paroxysmal atrial fibrillation are given a supply of oral flecainide or propafenone which they can use to self-treat whenever they get the random episode of atrial fibrillation
what is paroxysmal supraventricular tachycardia and what is the treatment for this
paroxysmal supraventricular tachycardia = random/ intermittent rapid heart rate that occurs in the atria.
treatment:
- often stops spontaneously
- can treat with reflex vagal stimulation such as a Valsalva manoeuvre, immersing the face in ice-cold water, or carotid sinus massage
- if previous treatments not effective, can give i.v adenosine or i.v verapamil (if adenosine intolerated)
what is Torsade de pointes
what is the treatment
a type of ventricular tachycardia that has a a prolonged QT interval. it is usually self-limiting but recurrent. if it’s not controlled it can progress to ventricular fibrillation and lead to death
treatment:
- I.V magnesium sulfate
- beta blocker (not sotalol)
