Arrhythmias Flashcards
Treatment of asymptomatic bradycardia >40bpm
No treatment needed
Stop any causative drugs if they are present
Check TFT
Treatment of bradycardia
Give atropine 0.6-1.2mg IV
If no response then insert a temporary pacing wire
If necessary isoprenaline infusion or external pacing
What is sick sinus syndrome?
Sinus node dysfunction causes bradycardia and or arrest
SA Node block or SVT alternating with bradycardia/asystole
Tachy-Brady syndrome
Management of sick sinus syndrome
Pace if symptomatic
Management of SVT
Vagotonic manoeuvres
Then
IV adenosine or verapamil if adenosine fails
Cardiogenic shock if compromised
Adenosine - when and how work?
SVT
Blocks AV node temporarily - resets heart
Maintenance therapy for SVT
Beta blocker or verapamil
Management of acute AF (
Control ventricular rate with beta blocker or verapamil
Or use digoxin or amiodarone
DC shock if compromised or IV amiodarone
Start anti coagulation - LMWH
Management of VT
Oxygen mask
Monitoring
IV amiodarone or lidocaine
Maintenance with amiodarone
If fails Dc cardio version
Management of WPW
Ablation of accessory pathway
Presentation of arrhythmias
Palpitations Chest pain Presyncope or syncope Hypotension Pulmonary oedema
Management of VF
DC shock
What is torsade de pointes?
looks like AF but VT with varying axis
Side effect of antiarrhythmics
Treatment of torsade de pointes?
Magnesium sulphate 2g IV over 10mins
Overdrive pacing
Management of chronic AF
Rate control - beta blocker or verapamil
Then digoxin
Then amiodarone
Anti coagulation
Can try cardio version
Alternative drug for pharmacological cardio version
Felcainide
Management of paroxysmal AF
Pill in pocket
Sotalol or flecainide
Management of atrial flutter
Carotid sinus massage and IV adenosine - to reveal flutter
Treatment with amiodarone to restore sinus rhythm and amiodarone or soltalol to maintain it
Acute AF anti-COAGULATION
use heparin until risk assessment done
Use warfarin of risk of emboli is high
If sinus rhythm obtained and no risk of emboli or risk of AF recurrence - then no anticoagulation is needed
Chronic AF anticoagulation
Warfarin and aim for INR 2-3
Aspirin less good alternative if warfarin CI
Maybe dabigatran