Arrythmias

Question 1

Treatment for New onset AF with haemodynamic instability

Answer 1

Electrical Cardioversion

Question 2

Arrhythmia Drugs 
Class 1 
Class 2 
Class 3
Class 4 
Other

Answer 2

Class 1 – membrane stabilising Na Chanel = Blockers 
Class 2 – Beta blockers
Class 3 – K+ Blockers 
Class 4 – CCB (rate limiting) 
Other – Adenosine / Digoxin

Question 3

New onset AF without haemodynamic instability

Answer 3

< 48 hours: Rate of Rhythm control (cardioversion is preferred)
> 48 hours: Rate control (Verapamil / Beta Blocker)

Question 4

Maintenance Treatment for AF

Answer 4

First line rate control = Monotherapy 
-	Beta Blocker (not Sotalol) 
-	Rate limiting CCB 
-	Verapamil 
Second line rate control = Dual therapy 
-	Beta blocker 
-	Diltiazem – Cardioselectivie CCB 
-	Digoxin 
Third line 
-	Rhythm control 
o	Beta blocker – Sotalol 
o	Oral arrhythmic drug

Question 5

Examples of oral arrhythmic drug (SAF)

Answer 5

Sotalol
Amiodarone
Flecainide

Question 6

What is the treatment options for Paroxysmal or symptomatic Afib treatment
‘when symptoms stop and start’

Answer 6

Pill in pocket “Flecanide or Propafenone’

Question 7

Best suitable treatment for Atrial Flutter

Answer 7

Catheter Ablation

Question 8

When do you consider stroke prevention in patients with Afib or Atrial flutter
(2)

Answer 8

Risk of thrombeometic stroke > risk of bleeding

CHADSVAS is 2 or more

Question 9

When do you give parental anticoagulation

Answer 9

New onset AF

Question 10

When do you give Warfarin or DOAC

Answer 10

Diagnosed AF

Question 11

Types of Ventricular Tachycardia (4)

Answer 11

• Pulseless of AF
• Unstable sustained ventricular tachycardia
• Stable sustained ventricular tachycardia
• Non - sustained ventricular tachycardia

Question 12

What do you do in each of these options

• Pulseless of AF
• Unstable sustained ventricular tachycardia
• Stable sustained ventricular tachycardia
• Non - sustained ventricular tachycardia

Answer 12

Pulseless AF = defib + CPR + Amiodarone

Unstable sustained ventricular tachycardia = directed current cardioversion

Stable sustained ventricular tachycardia
= IV anti-arrhythmic drugs

Non - sustained ventricular tachycardia = Beta Blocker

Question 13

What are your two options for maintenance treatment in ventricular tachycardia plus examples

Answer 13

Cardioverter defib implant

Drugs (Sotalol, beta blocker alone, beta blocker + Amiodarone)

Question 14

Treatment for patients with QT prolongation

Answer 14

Magnesium Sulphate

Question 15

Treatment for paroxysmal Super ventricular Tachycardia

“ACV”

Answer 15

Adenosine
Cardiac glycosides ‘Digoxin’
Verapamil hydrochloride.

Question 16

What is the treatment drug of choice for arrhythmias

Answer 16

Amiodarone

Question 17

Amiodarone dosing

Answer 17

200mg TDS 7DY
200mg BD 7DY
200mg OD maintenance

Question 18

Side effects of Amiodarone (go up from your head down) (7)

Answer 18

Peripheral Neuropathy 
Microdeposits in eyes 
Greys skin / SJS 
Thyroid Dysfunction
Pulmonary Fibrosis / Pneumonitis 
Hepatoxicity 
Hypokalaemia

Question 19

Monitoring for Amiodarone

think about side effects) (5

Answer 19

Annual blood test 
Chest X ray 
Thyroid 
Blood pressure 
Vitamin K

Question 20

Interaction with Amiodarone

Answer 20

enzyme inhibitor’

• Grapefruits
• Warfarin / Phenytoin / Digoxin
• Statins (increase risk of myopthay)
• QT prolongation drugs

Question 21

Dosing for Digoxin
- In atrial flutter / non paroxysmal AF in sedentary patients

• Worsening of severe heart failure in sinus

Answer 21

Long half life
AF = 125-250mcg

Heart failure = 62.5-125mcg

Question 22

Signs of digoxin toxicity + treatment

‘ Slow and sick’ (5)

Answer 22

GI 
Bradycardia 
Blurred vision / yellow skin 
Confusion 
Rash 

Treatment : withdraw and restore electrolyte imbalance

Question 23

Interaction of Digoxin

“ CRASED”

Answer 23

• CCB
• Rifampicin
• Amiodarone
• St Johns Wart
• Erythromycin
• Diuretics
• Drugs that reduce renal excretion
  NSAID’s / ACE / ARB’s