Arrhythmias 2: Atral flutter

Question 1

1) In general what is the treatment for atrial flutter?

2) True or false: Atrial flutter generally responds less well to drug treatment than atrial fibrillation

Answer 1

1) like AF, treatment for atrial flutter involves either controlling ventricular rate or attempting to restore and maintain sinus rhythm
2) true

Question 2

In atrial flutter, control of the ventricular rate is usually an interim measure pending restoration of sinus rhythm. which drugs are used to control rate in atrial flutter?

Answer 2

1) B-blocker, diltiazem or verapamil ; IV B-blocker or verapamil is preferred for rapid control.
2) Digoxin can be added if rate control remains inadequate, and may useful in those with heart failure

Question 3

How can conversion to sinus rhythm can be achieved in atrial flutter?

Answer 3

1) Electrical cardioversion
2) Pharmacological cardioversion
3) Catheter ablation

Question 4

what is the the treatment of choice when rapid conversion to sinus rhythm is necessary in atrial flutter?

Answer 4

1) Direct current cardioversion

2) catheter ablation is preferred for the treatment of recurrent atrial flutter

Question 5

Paroxysmal supraventricular tachycardia usually terminates spontaneously or with reflex vagal stimulation. what manouveres can be preformed to stimulate the vagal nerve?

Answer 5

1) Valsalva manoeuvre
2) Immersing the face in ice-cold water
3) Carotid sinus massage

Question 6

If vagal stimulation is ineffective, or if the arrhythmia is causing severe symptoms, what pharmacological treatment can be used?

Answer 6

1) IV adenosine
2) If ineffective IV verapamil is an alternative, but it avoid in those recently treated with B-blockers
3) Treatment with direct current cardioversion in haemodynamically unstable patients or when the above measures have failed to restore sinus rhythm

Question 7

how should pulseless ventricular tachycardia or ventricular fibrillation be treated?

Answer 7

Immediate defibrillation

Question 8

how should patients with unstable sustained ventricular tachycardia, who continue to deteriorate be treated?

Answer 8

1) Direct current cardioversion to restore sinus rhythm

2) if the above fails: IV amiodarone and direct current cardioversion repeated.

Question 9

how should patients with sustained ventricular tachycardia who are haemodynamically stable be treated?

Answer 9

1) Amiodarone is the preferred drug
2) Flecainide , propafenone
↳Non-sustained ventricular tachycardia can be treated with a beta-blocker

Question 10

what is torsade de pointes?

Answer 10

Form of ventricular tachycardia associated with a long QT syndrome. Episodes are usually self-limiting, but If not controlled, the arrhythmia can progress to ventricular fibrillation and sometimes death.

Question 11

what can cause torsade de pointes?

Answer 11

1) Drug-induced,
2) Hypokalaemia
3) Severe bradycardia
4) Genetic predisposition

Question 12

what is the treatment for torsade de pointes and which drugs should not be given?

Answer 12

1) IV infusion of magnesium sulfate i
2) beta-blocker (but not sotalol hydrochloride) and atrial (or ventricular) pacing can be considered.
3) Anti-arrhythmics can further prolong the QT interval, thus worsening the condition.