arrhythmias Flashcards
1
Q
rate limiting CCB
A
verapamil & diltiazem
2
Q
Tx if AF presentation in <48 hrs
A
rate or rhythm control
3
Q
Tx if AF presentation in >48 hrs
A
rate control
4
Q
urgent rate control
A
BB given IV
(rate limiting CCB if LVEF >40%)
5
Q
pharmacological cardioversion
A
- flecainide (no structural/ischaemic heart disease)
- amiodarone
6
Q
cardioversion strategies (rhythm control)
A
- electrical or pharmacological cardioversion (flecainide or amiodarone)
- AF >48hrs electrical preferred, but delay until anticoagulated for at least 3 weeks
7
Q
rate control
A
- 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
8
Q
rhythm control (cardioversion)
A
- 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)
9
Q
when to offer anticoagulaiton
A
- CHADSVASC 2 or more
- consider in men if 1
10
Q
types of anticoagulants that can be used
A
DOACS
- apixaban
- rivaroxaban
- dabigatran
- edoxaban
if not suitable - warfarin (vit K antagonist)
11
Q
anticoagulation for acute AF
A
- 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
12
Q
beta blockers in AF
A
- AF alone - atenolol
- AF + Hx MI - metoprolol, propranolol, atenolol
- AF + Hx HF - bisoprolol, carvedilol, nebivolol
13
Q
atenolol monotoring
A
HR
BP
14
Q
cardio selective BB
A
- atenolol
- bisoprolol
- nebivolol
- metoprolol
- acebutolol
15
Q
adverse effects of beta blockers
A
- 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
