Arrhythmias

Question 1

Name 3 types of tachyarrhythmias

Answer 1

AF, supraventricular tachycardia and ventricular tachycardia

Question 2

List some modifiable risk factors for AF

Answer 2

Dyslipidaemia, physical inactivity, alcohol, obesity, smoking

Question 3

Symptoms of AF? (Remember only 20% of Pts are symptomatic)

Answer 3

Palpitations, fatigue, chest tightness, dizziness, etc

Question 4

3 components of AF treatment?

Answer 4

1. Prevention of thromboembolism and stroke
2. Rate control
3. Rhythm control

Question 5

Verapamil and diltiazem act where in the heart?

Answer 5

AV node

Question 6

Name 2 drugs other than digoxin that act on the AV node to slow conduction and regulate rate?

Answer 6

Beta blockers and verapamil (ccb)

Question 7

Which 2 anti-arrhythmic drugs can be used in heart failure because they are Not negatively inotropic?

Answer 7

Digoxin and amiodarone

Question 8

2 drug Tx options for bradycardia?

Answer 8

Isoprenaline and atropine

Question 9

Compare haemodynamically stable vs unstable

Answer 9

Stable = stable blood flow, BP and HR

Question 10

Compare paroxysmal and persistent AF

Answer 10

Paroxysmal = spontaneously terminates within 7 days, but returns with varying frequency 
Persistent = longer than 7 days and does not spontaneously terminate

Question 11

First line drugs for rate control? Give 2 drug classes and examples

Answer 11

Non-dihydro CCBs - verapamil and diltiazem

Beta blockers - atenolol and metoprolol

Question 12

Which drug is second line for rate control - digoxin or amiodarone?

Answer 12

Digoxin. Amiodarone is 3rd / on specialist advice

Question 13

Which non-dihydropyridine CCB is worse for constipatjin - verapamil or diltiazem?

Answer 13

Verapamil

Question 14

Name 2 major considerations for digoxin use.

Answer 14

1. Only useful at rest. If patient is physically active, their HR will rapidly increase
2. Use with care in renal impairment

Question 15

Name 2 pre-treatment tests that need to be conducted for amiodarone

Answer 15

• Chest X-ray
• ECG
• thyroid function tests
• liver function tests
• electrolytes

Question 16

Best treatment for rhythm control? To return a patient to sinus rhythm.

Answer 16

Electrical cardioversion - DC shock.

More effective than drugs

Question 17

Name a transient cause of AF that might not require long term rhythm control

Answer 17

Alcohol use, myocardial infarction, thyroid problems

Question 18

2 possible drugs for rhythm control long term? After electrical cardioversion.

Answer 18

Flecainide, amiodarone or sotalol

Question 19

Which drug class is more useful in clot prevention in AF - anticoagulants or antiplatelets?

Answer 19

Anticoagulants.

Question 20

Name 3 DOACS

Answer 20

Dabigatran, Rivaroxaban, apixaban

Question 21

Compare warfarin and rivaroxaban dosing to apixaban and dabigatran.

Answer 21

Warfarin and rivaroxaban are once daily. The others are twice daily.

Question 22

When are antiplatelets used in AF stroke prevention?

Answer 22

They are not. Because not as effective as anticoagulants.

Question 23

Which drugs are contraindicated after an MI?

Answer 23

Flecainide and sotalol

Question 24

Major ADRs for amiodarone? (5)

Answer 24

Pulmonary toxicity, liver toxicity, hypothyroidism, AV block, electrolyte disturbances