Arrhythmias: 2

Question 1

Step 1: Hemodynamically Unstable?

Answer 1

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

Question 2

AF or AFL precipitated by states of high adrenergic tone are often resistant to..

Answer 2

Digoxin
so
ß-blockers are excellent choices

Question 3

Step 2: Rate Control

Answer 3

RATE

-LVEF >40: Metoprolol, Diltiazem, Verapamil +/- Digoxin

-LVEF <40: Metoprolol, Carvedilol +/- Digoxin

+ Warfarin or DOACs

Question 4

Step 2: Rhythm Control

Answer 4

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

Question 5

CHADSVASC Score

Answer 5

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

Question 6

DOACs Dosing for Non-Valvular AF

Answer 6

DABI: 150 BID

RIVA: 20 QPM

APIXA: 5 BID

EDOX: 60 QD

Question 7

Step 3: Prevention

Answer 7

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

Question 8

PSVT: Tx

Answer 8

1. Vagal Maneuvers and IV Adenosine
2. Stable
   -NO: Cardiovert
   -YES: Metoprolol 5 or Diltiazem 5-10
3. AVRT? Cardiovert
   AVNRT? IV Amio 150 x6h then 0.5 mg/min x18h or Cardiovert

Question 9

PSVT vs VT

Answer 9

PSVT = narrow complex = QRS < 0.12 sec

VT = often wide complex = QRS ≥ 0.12 sec

Question 10

Monomorphic VT Tx

Answer 10

WITH SHD
-Cardiovert
-Procainamide
-Amio
-Sotalol
-MG if TDP sus

(S PASM)

WITHOUT SHD
-Cardiovert
-Verapamil or BB

(WO BV)

Question 11

Sustained Monomorphic VT

Answer 11

1. Procainamide
2. Amiodarone
3. Sotalol
4. Verapamil
5. Beta-blocker

Question 12

Chronic, Recurrent, Sustained VT

Answer 12

-Amio or Sotalol

Question 13

Nonsustained VT

Answer 13

-BB
-Amio
-ICD

Question 14

Torsades de Pointes

Answer 14

Polymorphic VT

Unstable = Cardiovert

Stable = Mg Sulf 2 g IV
-Repeat Q6hr if QTC > 500

Secondary tx = Isoproterenol

Question 15

AV Block Tx

Answer 15

-Atropine 1 mg (up to 3)
-Epi or Dopamine (2-10 mcg)
-Isoproterenol (2-10 mcg)

Question 16

PEA/Asystotle

Answer 16

PEA: Organized electrical activity on the monitor but NO palpable pulse

Asystole: Lack of electrical activity on monitor

TX for both:
-CPR
-Epi 1 mg
-Vasopressin 40 u