Arrhythmias: 2 Flashcards

1
Q

Step 1: Hemodynamically Unstable?

A

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

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2
Q

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

A

Digoxin
so
ß-blockers are excellent choices

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3
Q

Step 2: Rate Control

A

RATE

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

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

+ Warfarin or DOACs

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4
Q

Step 2: Rhythm Control

A

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

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5
Q

CHADSVASC Score

A

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

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6
Q

DOACs Dosing for Non-Valvular AF

A

DABI: 150 BID

RIVA: 20 QPM

APIXA: 5 BID

EDOX: 60 QD

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7
Q

Step 3: Prevention

A

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

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8
Q

PSVT: Tx

A
  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
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9
Q

PSVT vs VT

A

PSVT = narrow complex = QRS < 0.12 sec

VT = often wide complex = QRS ≥ 0.12 sec

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10
Q

Monomorphic VT Tx

A

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

(S PASM)

WITHOUT SHD
-Cardiovert
-Verapamil or BB

(WO BV)

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11
Q

Sustained Monomorphic VT

A

1. Procainamide
2. Amiodarone
3. Sotalol

4. Verapamil
5. Beta-blocker

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12
Q

Chronic, Recurrent, Sustained VT

A

-Amio or Sotalol

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13
Q

Nonsustained VT

A

-BB
-Amio
-ICD

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14
Q

Torsades de Pointes

A

Polymorphic VT

Unstable = Cardiovert

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

Secondary tx = Isoproterenol

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15
Q

AV Block Tx

A

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

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16
Q

PEA/Asystotle

A

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