Arrthymias

Question 1

First line for atrial flutter ?

Answer 1

Question 2

First line for rapid control of ventricular rate in atrial fibrillation?

Answer 2

Question 3

List the drugs that increase the incidence of Torsa De point

Answer 3

Question 4

First line for Torsa de point

Answer 4

Question 5

What is AF?

Answer 5

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia resulting from irregular, disorganized electrical activity and ineffective contraction of the atria. The disorganised electrical impulses in that atria that causes them to fibrillate is usually at a rate of 300-600 bpm.

Question 6

What are the three classifications for AF according to patterns of episodes?

Answer 6

Question 7

What are non-cardiac causes of AF?

Answer 7

Non-cardiac conditions, such as:
○ Acute infection.
○ Autonomic neuronal dysfunction (such as vagally induced AF).
○ Electrolyte depletion (such as hypokalemia and hyponatremia).
○ Cancer (such as primary lung cancer involving the pleura and pericardium, and cancers such as breast cancer and malignant melanoma metastasising to the pericardium).
○ Pulmonary embolism.
○ Thyrotoxicosis
Diabetes mellitus

Question 8

What are the symptoms for suspected AF in people with an irregular pulse with or without any of the following?

Answer 8

Question 9

When should paroxysmal AF symptoms be suspected?
a. Less than 24 hours
b. Less than 48 hours
c. Less than 72 hours
Greater than 43 days

Answer 9

B . Suspect paroxysmal AF if symptoms are episodic and last less than 48 hours.

Question 10

What is the two driving group entitlements that result in banning from driving if arrthymia hasn’t been controlled in X amount month/time?

Answer 10

Question 11

• When is anticoagulant indicated in men and women WITH AF using X scoring system?

Answer 11

Question 12

• What does the CHA2DS2VASc stand for and what are the scoring bands?
  Congestive heart failure/left ventricular dysfunction (heart failure with reduced ejection fraction, or people with recent decompensated heart failure requiring hospitalization, irrespective of ejection fraction) = 1

Answer 12

Question 13

What tool is used to measure bleeding risk to help guide decisions on anticoagulation?

Answer 13

ORBIT Score.

Question 14

• What are is the range for patient with High ORBIT bleeding score risk?
  A. 2.5-3.5
  B. 4-6
  C. 5-8
  D. 4-7

Answer 14

D

Question 15

In Ptx presenting with AF acutely w/o hemodynamic instability what should be offered in the first 48 hours?

Answer 15

Question 16

When pharmacological cardioversion is agreed upon what is the first line agent used for Ptx with history of structural or ischemic heart disease presenting with new-onset AF?

Answer 16

Amiodarone

Question 17

What does NICE guidance say about the treatment AF Ptx with cardioversion for whom the duration of arrythmia is greater than 48 hours or uncertain (hemodynamically stable) and is considered for long term RHYTHM control? ( do you cardiovert or not?)

Answer 17

In people with atrial fibrillation in whom the duration of the arrhythmia is greater than 48 hours or uncertain and considered for long‑term rhythm control, delay cardioversion until they have been maintained on therapeutic anticoagulation for a minimum of 3 weeks. During this period offer rate control as appropriate. [NICE 1.8.6]

Question 18

What is first line anti-coagulant agent used in Ptx presenting with new-onset atrial fibrillation in whom a stable sinus rhythm has not been successfully restored within 48 hours of onset?

Answer 18

Question 19

• If atrial fibrillation has been present for more than 48 hours and patient needs to be electrically cardioverted what is the next line of treatment in terms of anti-coagulation?

Answer 19

Question 20

What is the first line therapy of choice in patients awaiting for cardioversion to maintain sinus rhythm? How long should they be continued on therapy?

Answer 20