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Cardiovascular System > Arrhythmias > Flashcards

Arrhythmias Flashcards

1
Q

What are the different types of arrythimias?

A
  1. Atrial Fib - the most common
  2. Atrial flutter
  3. Ectopic beats
  4. Paroxysmal atrial fibrillation
  5. Paroxysmal ventricular tachycardia
  6. Ventricular tachycardia
  7. Supraventricular tachycardia
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2
Q

What is Atrial Fibrillation?

A

A type of arrhythmia that causes irregular and often very rapid heart rhythm.

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3
Q

What are symptoms of atrial fibrillation ?

A

Shortness of breathe, dizziness, palpitations, syncope, chest discomfort, stroke/T.I.A

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4
Q

What is the aim of treatment for atrial fibrillation?

A

Reducing the symptoms and preventing complications by either controlling the ventricular rate (rate control) or restoring and maintaining sinus rhythm (rhythm control)

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5
Q

What must happen annually with all patients with atrial fibrillation?

A

Annually, anticoagulation, stroke and bleeding risk must be reviewed.

And thromboembolism risk.

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6
Q

What are the treatment options for Arrythmias?

A
  • Medication
  • Cardioversion
  • Artificial pacemakers
  • Implantable cardioverter defibrillators (ICDs)
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7
Q

What are ectopic beats and what is the treatment for it?

A

This is missed beats.
Usually no treatment is required, but if troublesome, beta-blockers are usually used as they’re effective and safer than other suppressant drugs

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8
Q

Patients with life threatening haemodynamic instability caused by new onset atrial fibrillation should undergo what?

A

Emergency electrical cardioversion

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9
Q

Patients with non-life threatening haemodynamic instability presenting acutely should be given what?

A

If onset of arrhythmia is less than 48 hours, rate or rhythm control can be offered

If onset is more than 48 hours, rate control only

If hours are uncertain, rate control only

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10
Q

What should be offered to patients with new onset AF (acute) if on no anticoagulants?

A

They should be given Heparin - parenteral anticoagulation - until an assessment and the appropriate anticoagulant can be given

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11
Q

What is the first line treatment for Oral anticoagulants?

A

DOACs like apixaban, edoxaban, rivaroxaban, pradaxa.

If these are contra-indicated, (renal impairment), then given Vitamin K antagonist like Warfarin.

But only give to patients with confirmed AF

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12
Q

What are the different types of arrythmias and their treatment?

A

Supraventricular arrhythmias - Verapamil, adenosine and cardiac glycoside

Ventricular arrhythmias - Lidocaine, sotalol

Amiodarone and beta blockers can be used for - Supraventricular and ventricular arrhythmias

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13
Q

What is the Vaughn-Williams classification?

A

The classification according to the effects on electrical activity of the heart

Class 1 - Membrane stabilising drugs (Sodium channel blockers):
- Lidocaine, flecainide

Class 2 - Beta blockers

Class 3 - Potassium channel blockers:
- Amiodarone, dronedarone, propafenone, sotalol (also in class 2)

Class 4 - Non-dihydropyridine calcium channel blockers:
- Diltiazem, verapamil

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14
Q

What is the preferred first line drug treatment for atrial fibrillation?

A

Rate control; such as:

  • Beta blockers
  • Diltiazem
  • Verapamil
  • Digoxin

NOT SOTATLOL

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15
Q

When can the first line treatment for atrial fibrillation not be used?

A

In patients with new onset atrial fibrillation.

In patients with atrial flutter that can be given ablation strategy

In patients with atrial fibrillation with a reversible cause

If heart failure primarily caused by AF

If rhythm control is more suitable

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16
Q

What drugs can control ventricular rate?

A
  1. A standard beta blocker except sotalol hydrochloride.
  2. A rate limiting calcium channel blocker such as diltiazem hydrochloride or verapamil hydrochloride as monotherapy
  3. Digoxin, but only for controlling ventricular rate at rest.
    This must be used as monotherapy in sedentary patients with non-paroxysmal atrial fibrillation

Digoxin is also used when atrial fibrillation is accompanied by congestive heart failure

All as monotherapy for first-lines

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17
Q

What must be done if a single drug fails to control the ventricular rate?

A

A combination of two drugs can be used; including, beta-blocker, digoxin, diltiazem hydrochloride.

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18
Q

What should be done if symptoms are not controlled with a combination of two drugs?

A

A rhythm control strategy should be considered.
This includes:

  • Beta blockers (NOT SOTALOL AS FIRST LINE)
  • Amiodarone
  • Dronedarone
  • Propafenone
  • Flecainide
  • Sotalol (just not as first line)

fab rhythm spd

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19
Q

What are the two types of cardioversion?

A

Pharmacological cardioversion (flecainide or amiodarone)

and

Electrical cardioversion

20
Q

Who should flecainide acetate and propafenone hydrochloride not be given to?

A

Patients with known ischaemic or structural heart disease.

21
Q

In terms of cardioversion, what is preferred if atrial fibrillation has been present for more than 48 hours?
And what should be done beforehand?

A

Electrical is preferred over pharmacological cardioversion.
But there must be a delay until the patient has been fully anticoagulated for at least 3 weeks, due to risk of stroke.

If this is not possible, parenteral anticoagulation (heparin) should commence and left atrial thrombus should be ruled out immediately before starting cardioversion.

Rate control can also be offered before cardioversion.

22
Q

What should be given after cardioversion?

A

Oral anticoagulants for at least 4 weeks

23
Q

What is the tool used to assess risk of stroke in atrial fibrillation?

A

CHA2 DS2 VASc assessment tool

Other include ATRIA stroke risk tool and QStroke calculator

24
Q

What assessment is used to calculate bleeding risk in arrhythmias?

A

ORBIT

Others include HASBLED and ATRIA.
But ORBIT is more accurate but hasn’t been embedded into some GP and hospitals yet

25
Q

What does CHADSVASC stand for / what are the factors of CHADSVASC?
And what does the result mean?

A

Congestive Heart Failure – 1
Hypertension – 1
Age – 1 (>65) or 2 (>75)
Diabetes – 1
Stroke/TIA/Thromboembolism – 1
Vascular Disease – 1
Female – 1

Results:
Requires anticoagulation if males = >0 or females = >1

Any score that is 2 or more, regardless of gender give anticoagulation

26
Q

What is vascular disease in CHADSVASC?

A
  • Previous MI
  • Peripheral arterial disease
  • Aortic plaque
27
Q

What are the factors of ORBIT?
And what does the result mean?

A
  • Older than 75 – 1
  • Reduced Haemoglobin (history of anaemia) – 2
  • Bleeding History – 2
  • Inadequate Renal Function – 1
  • Treatment with Antiplatelets – 1

Results:
0-2 – Low risk of bleeding
3 – Medium risk of bleeding
4-7 – High risk of bleeding

28
Q

?? What is the drug treatment for haemodynamic instability?

A

Intravenous amiodarone hydrochloride or flecainide acetate.

If the patient has structural heart disease, amiodarone hydrochloride is preferred

29
Q

?? What can be given as urgent rate control?

A

A beta-blocker or verapamil hydrochloride, intravenously

30
Q

What should be done if ventricular function is diminished?

A

A combined of a beta blocker (that is licensed for use in heart failure) and digoxin is preferred.

31
Q

What can be used if rhythm control (maintaining sinus rhythm) is needed after cardioversion?

A

A standard beta blocker

32
Q

What should be given if a standard beta blocker cannot be used for rhythm control (maintaining sinus rhythm) after cardioversion?

A

An oral anti-arrhythmic drug such as sotatol hydrochloride, flecainide acetate, propafenone hydrochloride or amiodarone hydrochloride, or dronedarone

33
Q

What can be done to increase success of cardioversion procedure?

A

Amiodarone hydrochloride can be started 4 weeks before and continued for up to 12 months after the electrical cardioversion procedure

34
Q

What should be considered for those with left ventricular impairment or heart failure?

A

Amiodarone

35
Q

What drug is used to control symptomatic paroxysmal atrial fibrillation?

A

A standard beta blocker, used to control ventricular rhythm

36
Q

What should be given if symptoms persist or a standard beta blocker is not appropriate in paroxysmal atrial fibrillation?

A

An oral anti-arrhythmic drug such as dronedarone, sotalol hydrochloride, flecainide acetate, propafenone hydrochloride or amiodarone hydrochloride

37
Q

When is the pill-in-the-pocket approach given?

A

In selected patients with infrequent episodes of symptomatic paroxysmal atrial fibrillation

38
Q

What is the pill-in-the-pocket approach?

A

When the patient takes oral flecainide acetate or propafenone hydrochloride to self treat an episode of atrial fibrillation

39
Q

What assessment tool is used to assess bleeding risk in atrial fibrillation patients prior to and during anticoagulation?

A

HAS-BLED tool

40
Q

Examples of beta blockers?

A
  • Atenolol (also called Tenormin)
  • Bisoprolol (also called Cardicor or Emcor)
  • Carvedilol
  • Labetalol (also called Trandate)
  • Metoprolol (also called Betaloc or Lopresor)
  • Propranolol
41
Q

What’s bradycardia, tachycardia and a normal heart rate?

A

Normal rate is 60-100bpm
Less than 60bpm is bradycardia
More than 100bpm is tachycardia

42
Q

What are the causes of arrythmia?

A
  • Coronary heart disease
  • Heart valve disease
  • Hypertension
  • Cardiomyopathy
  • Congenital abnormalities in the electrical pathways
43
Q

What should be given to acute new onset of AF that is life threatening?

A

Rhythm control should be given via emergency electrical cardioversion

44
Q

When can paternal anticoagulation be given?

A

Heparin can be offered to patients with new acute onset of AF, who are not taking any anticoagulants.

This should be done until an assessment is made and an appropriate anticoagulant is started.

45
Q

What oral anticoagulants can be given in AF?

A

NOACs are recommended as first line treatment.
If contra-indicated, give warfarin.

Oral anticoagulants are given to all pts with confirmed AF

Cardiovascular System (9 decks)

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