Arrythmias

Question 1

Sinus rhythm can be restored by pharmacological cardioversion using what drugs?

Answer 1

Amiodarine or flecanide oral or IV

Question 2

If atrial fibrillation is present for more than 48 hour which type of cardioversion (electrical or pharmacological) is recommended?

Answer 2

Electrical

Question 3

Which beta blocker is not recommended in ventricular control?

Answer 3

Sotalol, can occasionally cause life threatening ventricular arrythmia and may prolong QT interval

Question 4

What CCBS can be used for rate limiting ventricular control?

Answer 4

Dilitazem and verapamil

Question 5

Dividing monotherapy is usually seen in elderly patients, why is this?

Answer 5

Usually only effective for controlling ventricular rate at rest so only used as monotherapy in predominantly sedentary patients with paroxysmal AF

Question 6

Combination therapy may be required if pts aren’t adequately controlled, what combination of drugs favours pts whose ventricular function has diminished?

Answer 6

Beta blocker and digoxin

Question 7

What drug is recommended when AF is accompanied by congestive HF?

Answer 7

Digoxin

Question 8

What treatment is recommended in maintaining sinus rhythm post cardioversion?

Answer 8

Standard beta blocker, also used for ventricular rythm control in paroxysmal AF

Question 9

What s the pill in the pocket concept?

Answer 9

A patient with paroxysmal AF experiences episodes of AF with symptoms which can last up to 7 days, a pill in the pocket is used to self treat when an episode occurs and is usually given oral flecanide or propafenone.

Question 10

What risk tools are used to identify the risks and benefits of stroke prevention in AF pts?

Answer 10

CHA2DS2VASc- CHF or LVEF, HT, Age>75, Diabetes, Prior stroke/TIA/thromboemobolism, vascular disease, Age, Sex
HAS-BLED, HT, renal function, prior stroke, prior bleeding, Labile INR, Elderly (+65), Drugs with bleeding risk

Question 11

Anticoagulation treatment should not be withheld solely due to risks of falls!

Answer 11

.

Question 12

Can aspirin monotherapy be used in stroke prevention?

Answer 12

No , it is less effective than warfarin and its benefits are offset by risk of bleeding

Question 13

Tx for atrial flutter are very similar for AF using drugs to control ventricular rate or sinus rhythm, in terms of success rate which condition is easier to manage?

Answer 13

AF. Atrial fibrillation responds less well to drug treatment

Question 14

What type of arythmia is a medical emergency?
Atrial flutter
Supraventricular Tachycardia
Atrial fibrillation
Ventricular Tachycardia

Answer 14

Ventricular Tachycardia

Question 15

What type of arrhythmia is associated with a long QT syndrome?

Answer 15

Torsade de Pointes

Question 16

Anti-arrhythmic drugs can be classedin 2 ways, the Vaughan Williams classification and those that act on arrhythmic types

Answer 16

Vaughan Williams classification uses class numbers which has less clinical significance. The other classification determins its uses, Verapamil acts on supraventricular, amiodarone both supra and ventricular, lidocaine acts on ventricular

Question 17

Arrhythmic drugs have negative ionotropic effects which tends to be additive.

Answer 17

If a combination of anti-arrhythmic drugs are used care should be taken especially if myocardial function is impaired

Question 18

Disopyramide is a useful antiarrhythmic which can be administered iv or oral, however it has antimuscarinic effects which may make it unsuitable in what conditions?

Answer 18

Angle-closure glaucoma

Prostate hyperplasia

Question 19

Cardiac glycosides and verapamil are useful for what type of arrhythmias?

Answer 19

Supraventricular

Question 20

Iidocaine HCl is useful for which type of arrhythmias?

Answer 20

Ventricular

Question 21

Amiodarone, beta blockers, disopyramide, flecanide, procainamide and propafenone are useful in what type of arrhythmias?

Answer 21

Both supraventricular and ventricular

Question 22

What can be given as treatment for life threatening digoxin toxicity?

Answer 22

Withdraw digoxin, treat clinical manifestations, Digoxin specific antibodies are available.

Question 23

What is iv digoxin not recommended for persistent tachycardia?

Answer 23

Response may take mtany hours

Question 24

What organ system plays the most important factor in determining digoxin dose?

Answer 24

Renal function

Question 25

It can be difficult to distinguish between toxic effects and clinical deterioration because symptoms of both are similar. plasma concentrations alone cannot indicate toxicity reliably but likelihood of toxicity occurs when concentrations range from 1.5-3 mcg/litre

Answer 25

.. symptoms include nausea, vomiting and irregular heartbeat

Question 26

Hypokalemia pre disposed the patient to digitalis toxicity, how can this be managed?

Answer 26

Potassium spring diuretics or potassium supplements

Question 27

What antiarrythmic class is amiodarine in?

Answer 27

Class 3

Question 28

Why does thyroid function tests need to be undertaken before amiodarone treatment and 6 months thereafter?

Answer 28

Amiodarone contains iodine, offseting throid function and causing hypo/hyperthyroidism. Hypothyroidism can be treated with replacement therapy without withdrawing amiodarone, careful supervision may be required.

Question 29

What other monitoring may need to be required for amiodarone treatment?

Answer 29

Liver function before treatment and every 6 thereafter as amiodarone is associated with hepatoxicity- discontinue if severe liver failure develops
Serum potassium to be measured before treatment
Chest x-ray before treatment as pneumonitis can develop when taking amiodarone, monitor for new or progressive SOB or cough.

Question 30

What anti viral medications are to be used in caution with amiodarone?

Answer 30

Sofosbuvir and daclatasvir, simeprivir and sofosbuvir, sofosbuvir and ledipasvir. Risk of severe bradycardia and heart block, need appropriate 48 hour monitoring after starting treatment, monitoring also required if amiodarone was stopped a few monhs earlier prior to antiviral treatment.

Question 31

What topical preparation would you also advise patient to use whilsttakong amiodarone?

Answer 31

Sunscreen, due to posibility of phototoxic reactions, shield the skin from light during treatment and for several month after discontinuing,