Arrhythmias: 2 Flashcards
Step 1: Hemodynamically Unstable?
YES
-Cardiovert to NSR
-Hep 60/12 or Enox 1 mg/kg BID SQ
-4 weeks oral AC (Warfarin or DOACs)
NO
-DHF: Amio or Digoxin
-NO DHF: Esmolol, Metoprolol, Diltiazem, Verapamil
-Hep 60/12 or Enox 1 mg/kg BID SQ
-Go to Step 2
AF or AFL precipitated by states of high adrenergic tone are often resistant to..
Digoxin
so
ß-blockers are excellent choices
Step 2: Rate Control
RATE
-LVEF >40: Metoprolol, Diltiazem, Verapamil +/- Digoxin
-LVEF <40: Metoprolol, Carvedilol +/- Digoxin
+ Warfarin or DOACs
Step 2: Rhythm Control
AF > 48 hr?
Yes
-3-6 wks AC
No
-Continue Hep/LMWH
*
Cardiovert or Pharmvert:
-LVEF <40: Amio
-Normal LV: Ibutilide, Amio, Procainamide
-Normal LV outside hospital: Propafenone, Flecainide
-4 wks AC
CHADSVASC Score
Age
-75+: 2
-65-74: 1
Diabetes: 1
Female: 1
HF: 1
HTN: 1
Stroke/TIA/TE: 2
Vascular disease: 1
High risk is 2 in men, 3 in women
DOACs Dosing for Non-Valvular AF
DABI: 150 BID
RIVA: 20 QPM
APIXA: 5 BID
EDOX: 60 QD
Step 3: Prevention
Prevent Stroke
-Low risk: omit
-Int risk: consider
-High risk: warfarin, apixa, riva, dabi, endox
Maintain NSR
-Normal LV, no MI or SHD:
*Dofetilide, Dronedarone, Flecainide, Propafenone, Amio, Sotalol
-MI, SHD, LVEF <40:
*Amio, Dofe, Drone, Sotalol
PSVT: Tx
- Vagal Maneuvers and IV Adenosine
- Stable
-NO: Cardiovert
-YES: Metoprolol 5 or Diltiazem 5-10 - AVRT? Cardiovert
AVNRT? IV Amio 150 x6h then 0.5 mg/min x18h or Cardiovert
PSVT vs VT
PSVT = narrow complex = QRS < 0.12 sec
VT = often wide complex = QRS ≥ 0.12 sec
Monomorphic VT Tx
WITH SHD
-Cardiovert
-Procainamide
-Amio
-Sotalol
-MG if TDP sus
(S PASM)
WITHOUT SHD
-Cardiovert
-Verapamil or BB
(WO BV)
Sustained Monomorphic VT
1. Procainamide
2. Amiodarone
3. Sotalol
4. Verapamil
5. Beta-blocker
Chronic, Recurrent, Sustained VT
-Amio or Sotalol
Nonsustained VT
-BB
-Amio
-ICD
Torsades de Pointes
Polymorphic VT
Unstable = Cardiovert
Stable = Mg Sulf 2 g IV
-Repeat Q6hr if QTC > 500
Secondary tx = Isoproterenol
AV Block Tx
-Atropine 1 mg (up to 3)
-Epi or Dopamine (2-10 mcg)
-Isoproterenol (2-10 mcg)