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Cardiovascular Disease > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

Positive inotropic effect

A

Depolarisation effect
Makes your heart muscle contractions stronger
Increased cardiac output to a normal level
Increases the amount of blood our heart can pump out
Examples: dopamine, digoxin, adrenaline

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2
Q

Negative inotropic effect

A

Hyperpolarisation effect
Weaken the heart’s contractions
Slow heart rate
Treat high blood pressure, heart failure, angina
Examples: beta blockers, flecainide, RL-CCB, digoxin

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3
Q

Treatment for ectopic beats

A

Beta blockers - rarely used as these are spontaneous and resolve without treatment

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4
Q

Types of atrial fibrillation

A

Paroxysmal - occurs intermittently and stops on its own within 7 days
Non-paroxysmal - persistent and lasts longer than 7 days
Long-standing persistent - lasts longer than a year

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5
Q

Treatment of acute AF with life-threatening haemodynamic instability

A

Emergency electrical cardioversion without delay to achieve anticoagulation

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6
Q

Treatment of acute AF without life-threatening haemodynamic instability if onset <48 hours

A

Rate or rhythm control

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7
Q

Treatment of acute AF without life-threatening haemodynamic instability if onset >48 hours

A

Rate control only

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8
Q

Examples of drugs for cardioversion (rhythm control) in acute AF without life-threatening haemodynamic instability if onset <48 hours

A

Flecainide, amiodarone

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9
Q

Maintenance treatment of non-paroxysmal AF

A

1st: Monotherapy rate control with beta blocker, RL-CCB or digoxin
2nd: Dual therapy with two of the first line drugs
3rd: Rhythm control with sotalol, propafenone, amiodarone, flecainide or dronedarone

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10
Q

Treatment if onset non-paroxysmal AF is >48 hours and what is required before initiating this treatment

A

Electrical cardioversion
Patient must be fully anticoagulated for at least 3 weeks before and 4 weeks after

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11
Q

Treatment of paroxysmal AF with symptomatic episodes

A

Pill in pocket approach with flecainide
I seen in practice atenolol being used for this

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12
Q

When would digoxin be used as first line for non-paroxysmal AF?

A

In predominately sedentary patients where beta blocker or RL-CCB doesn’t control symptoms

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13
Q

Drug treatment that may be required post electrical cardioversion

A

Standard beta blocker
Sotalol, propafenone, amiodarone, or flecainide

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14
Q

When should amiodarone be started and for how long should it be continued after electrical cardioversion?

A

4 week before and continued for up to 12 months after

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15
Q

Treatment of paroxysmal AF

A

1st: Standard beta blocker
2nd: Sotalol, Propafenone, Amiodarone or Flecainide

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16
Q

How to assess risk of stroke? What is the score that required anticoagulation therapy?

A

CHADsVASc
Men = >1
Women = >2

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17
Q

Treatment of atrial flutter

A

Reacts less effectively to drug treatment so treat with direct current cardioversion or catheter ablation

Temporary rate control with beta blocker or RL-CCB until sinus rhythm restored

18
Q

When would direct current cardioversion be used to restore sinus rhythm in atrial flutter?

A

When haemodynamic instability is present

19
Q

When would catheter ablation be used to restore sinus rhythm in atrial flutter? What must you ensure before treatment?

A

Recurrent atrial flutter
Patient has been anticoagulated for 3 weeks if flutter lasts longer than 48 hours

20
Q

Treatment of paroxysmal supraventricular tachycardia

A

1st: Usually terminates spontaneously by itself
2nd: Reflex vagal stimulation e.g., immerse face in ice-cold water or carotid sinus massage with ECG monitoring
3rd: IV adenosine
4th: IV verapamil but should be avoided if recently treated with beta-blocker

21
Q

Treatment of recurrent symptoms of paroxysmal supraventricular tachycardia

A

Catheter ablation

22
Q

Prevention of further episodes of paroxysmal supraventricular tachycardi

A

Beta blockers, Flecainide, Propafenone, or RL-CCB

23
Q

Treatment of arrhythmias post-MI

A

Tachycardia
Best not to administer anti-arrhythmic until ECG record

Bradycardia
1st: IV atropine
2nd: IVI adrenaline

24
Q

Treatment of Pulseless Ventricular Tachycardia or Ventricular Fibrillation

A

Resuscitation

25
Q

Treatment of unstable sustained ventricular tachycardia

A

Direct current cardioversion followed by IV amiodarone
Repeat current cardioversion if necessary

26
Q

Treatment of stable ventricular tachycardia

A

Amiodarone
Flecainide, propafenone, lidocaine (less so)

27
Q

Treatment of stable ventricular tachycardia if sinus rhythm not restored

A

Direct current cardioversion or catheter ablation

28
Q

Treatment of non-sustained ventricular tachycardia

A

Beta blocker

29
Q

Maintenance treatment for patients with ventricular tachycardia

A

Only used if high risk of cardiac arrest
Implantable cardioverter defibrillator
Can add beta blocker / amiodarone

30
Q

Treatment of Torsade’s de Pointes

A

Usually self-limiting

IV magnesium sulphate
Beta blocker and atrial / ventricular pacing

NOT AN ANTI-ARRHYTHMIC (can cause QT prolongation)

31
Q

Drugs that can cause Torsade’s de Pointes

A

Amiodarone
Sotalol
Macrolides
Haloperidol
SSRIs
TCAs
Antifungals
Lithium

32
Q

Treatment of Supraventricular Arrhythmias

A

IV Adenosine
IV Verapamil followed by oral treatment is preferred if asthmatic
Oral digoxin (IV not effective for rapid control of ventricular rate)
IV beta blocker can achieve rapid control

33
Q

When would verapamil be contraindicated?

A

AF or atrial flutter WITH Wolff-Parkinson White Syndrome

34
Q

Drugs used for both Supraventricular and Ventricular Arrhythmias

A

Amiodarone
Beta blockers
Disopyramide
Flecainide
Procainamide
Propafenone

35
Q

How many anti-arrhythmic drug classifications are there?

A

4

36
Q

How are the anti-arrhythmic drugs classified?

A

According to the primary mechanism of action

37
Q

Class I anti-arrhythmic

A

Membrane stabilising drugs - block sodium channels (sodium influx inhibited)

Rapid inhibition: Lidocaine

Slow inhibition: Flecainide, propafenone

38
Q

Class II anti-arrhythmic

A

Beta blockers

39
Q

Class III anti-arrhythmic

A

Prolong the cardiac action potential by inhibiting potassium efflux
Amiodarone, sotalol

40
Q

Class IV anti-arrhythmic

A

Inhibit calcium influx
RL-CCB

41
Q

Why isn’t sotalol used as rate control?

A

Can prolong the QT interval which can occasionally lead to life threatening ventricular arrhythmias

42
Q

Sotalol monitoring requirements

A

ECG and measurement of corrected QT interval
Serum electrolytes (K+ , Mg2+, Ca2+)

(electrolyte disturbance i.e. hypokalaemia, hypomagnesaemia, and hypercalcaemia, should be corrected before starting sotalol and during its use)

Cardiovascular Disease (11 decks)

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