arrhythmias Flashcards
rate limiting CCB
verapamil & diltiazem
Tx if AF presentation in <48 hrs
rate or rhythm control
Tx if AF presentation in >48 hrs
rate control
urgent rate control
BB given IV
(rate limiting CCB if LVEF >40%)
pharmacological cardioversion
- flecainide (no structural/ischaemic heart disease)
- amiodarone
cardioversion strategies (rhythm control)
- electrical or pharmacological cardioversion (flecainide or amiodarone)
- AF >48hrs electrical preferred, but delay until anticoagulated for at least 3 weeks
rate control
- first line (unless suitable for rhythm)
- BB (not sotalol) or rate limiting CCB (diltiazem, verapamil)
- digoxin monotherapy only if non-paroxysmal AF who are sedentary/others not suitable, when AF + CHF
- monotherapy fails: combination of 2 of BB, diltiazem, digoxin
- not controlled - then rhythm control
rhythm control (cardioversion)
- new onset AF (<48hrs), reversible cause (chest infection), HF (caused/worsened)
- BB (not sotalol)
- BB not suitable, alt anti-arrhythmic - amiodarone, flecainide, propafenone, sotalol
- amiodarone if HF/structural heart disease
- dronedarone - persistent paroxysmal AF, infrequent, pill in the pocket (to restore sinus rhythm)
when to offer anticoagulaiton
- CHADSVASC 2 or more
- consider in men if 1
types of anticoagulants that can be used
DOACS
- apixaban
- rivaroxaban
- dabigatran
- edoxaban
if not suitable - warfarin (vit K antagonist)
anticoagulation for acute AF
- new onset: heparin (at initial presentation, until appropriate anticoag started)
- confirmed diagnosis, onset <48hrs: oral anticoag if sinus rhythm not restored in 48hrs, high risk of recurrence, CHADsVASc
- unsure of time since onset - CHADSVASC
beta blockers in AF
- AF alone - atenolol
- AF + Hx MI - metoprolol, propranolol, atenolol
- AF + Hx HF - bisoprolol, carvedilol, nebivolol
atenolol monotoring
HR
BP
cardio selective BB
- atenolol
- bisoprolol
- nebivolol
- metoprolol
- acebutolol
adverse effects of beta blockers
- bradycardia
- hypotension
- cold extremities
- disturbed sleep, nightmares (less likely with atenolol - water soluble)
- sexual dysfunction
- hypoglycaemia or hyperglycaemia (+- diabetes)
- mask signs of hypoglycaemia
- withdrawal effects
- fatigue
CCBs for AF
- rate limiting - diltiazem (off label), verapamil
CCB interaction
simvastatin - cap at 20mg
CCBs in HF
avoid - except amlodipine
CCB s/e
headache
dizziness
hypotension
bradycardia
amiodarone dose
- loading dose - 200mg TDS 1 week, 200mg BD 1 week, 200mg daily maintenance
amiodarone adverse effects
- eyes, heart, lung, liver, thyroid, skin, nervous system adverse effects
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