Arrhythmias Flashcards
What is arrhythmia
Abnormal rate and rhythm due to an issue with the electrical conducting system
How are arrhythmias detected
ECG
What is the normal heart rate
60 to 100 bpm
What is it called when it is below 60bpm
Bradycardia
What is it called when above 100bpm
Tachycardia
What is paroxysmal AF
It stops within 7 days, usually without treatment
What is the treatment for paroxysmal AF
Pill in the pocket - patient manages this by taking an arrhythmic drug only when episode of AF starts
FAB (flecainide, amiodarone, BB)
What are some symptoms of arrhythmias
SOB, abnormal, fast, slow, irregular pulse and palpitations
What electrolyte imbalance can cause arrhythmias
Hypokalaemia
What is the aims of treatment for arrhythmias
Assess the risk of stroke, thromboembolism and balance these with bleeding risk and manage the symptoms
In AF acute presentation, what do you do when its life threatening?
Emergency electrical cardioversion (rhythm control)
In ACUTE NON LIFE threatening, what do you give when the time is less than 48 hours
Rate or rhythm control
In ACUTE NON LIFE threatening, what do you give when the time is more than 48 hours
Rate or rhythm but rate controlled is preferred (since it has been more than 48 hours)
If rhythm is preferred, then just do electrical cardioversion but should be delayed until 3 weeks of anticoagulation has passed.
What if 3 weeks of anticoagulation hasn’t passed?
Give heparin and give anticoagulant for 4 weeks
Doacs should be given, unless contraindicated i.e. renal failure in which warfarin should be given
What are some pharmacological cardioversions (rhythm)
Amiodarone, flecainide, dronedarone
What are some pharmacological rate controls
Beta blockers except sotalol
Verapamil, diltiazem and digoxin
DIVED BETA
If the DIVED beta do not work in controlling symptoms, what can be used?
Dual therapy with BB and DD
Remember, verapamil should not be used with beta blockers
What if even the dual therapy with BB DD does not work?
Consider rhythm control instead
FAB SPD
Flecainide (avoid in heart disease)
Amidarone
Beta blocker (first line)
Sotalol (not first line)
Propafenone (avoid in heart disease)
Dronedarone
What is used in supraventricular arrhythmias?
Verapamil hydrochloride, adenosine
What is used in ventricular arrythmias?
Lidocaine hydrochloride
Supraventricular + ventricular arrhythmias
Amiodarone
What is Torsade de pointes
Long QT prolongation
Is torsade de pointes usually self limiting
Yes but if not controlled, can lead to death
What antiarrhythmics can lead to QTC prolongation
Amidarone
Sotalol
Flecainide
