arrythmias, VTE Flashcards
what is arrythmia?
abnormal rate and rhythm
what is the normal heart rate in beats per minute?
60-100
what does a heart rate of under 60 beats per min indicate?
what does a heart rate of over 100 beats per min indicate?
under 60 = bradycardia
over 100=tachycardia [taky taky rumba]
what is paroxysmal atrial fibrillation?
this is managed by something known as pill in pocket. explain this.
episodes of AF that stop within 7 days [usually 48 hours] without treatment
pt can just take anti-arrythmic drugs only when an episode of AF occurs
what are the signs and symptoms of arrythmia?
sad palpitations
shortness of breath
abnormal fast/slow heart rate
dizziness
palpitations
what are some causes of arrythmias?
anything that affects the heart
coronary heart disease valvue disease hypertension ageing cardiomyopathy congenital birth defects
list the different types of arrythmias and which is the most common one? [6]
artrial fibrillation - most common ectopic beats supraventricular arrhythmia's ventricular arrhythmia paroxysmal AF atrial flutter
what is the treatment aim for treating arrhythmias?
treat the underlying cause of the arrythmia eg hypertension
what are the treatment options for arrythmias?
medication
cardioversion: electrical [electrical shock] or pharmacological
artificial pacemakers
implantable cardioverter defibrillators
what is the treatment aim for atrial fibrillation?
what do patients with AF have a high risk of?
reduce symptoms and prevent complications
high risk of stroke
what 2 things must be assessed in patients with AF prior and during anticoagulation?
assess risk of stroke and bleeding
what tools are used to assess risk of stroke? what tools are used to assess risk of bleeding?
stroke: CHA2DS2VASC
Bleeding: HASBLED / orbit
when are anticoagulants considered for patients with AF?
when risk of stroke greater than risk of bleeding
what are the associated risk factors with stroke for the CHA2DS2VASC and the associated scored?
c - congestive heart failure 1 H - hypertension 1 A - age over 75 2 a - age 65-74 1 d- diabetes = 1 S - stroke/tia/thromboembolism 2 V - vascular disease - 1 s - sex / gender female 1
what does a score of 2 or more on the chadsvasc tool indicate?
you will need an anticoagulant regardless of gender
anTWOcoagulants
what is the chadsvasc score for males and females generally?
male = 0 female = 1
what score must you get for hasbled that would indicate high risk of bleeding?
3
THREE makes you BLEED so do not give anticoagulant
what are the risk factors for HASBLED and the associated score?
what is the maximum score?
hypertension. 1 abnormal renal/liver function. 1 or 2 stroke. 1 bleeding tendency. 1 labile INR. 1 age greater than 65. 1 drugs [nsaids, concomitant aspirin] or alcohol. 1 or 2
max score 9
what are the risk factors for ORBIT and the associated scores?
what is the max score for orbit?
older than 74 - 1 reduced haemoglobin - 2 bleeding history - 2 inadequate renal function - 1 treatment with antiplatelet - 1
max score = 7
interpret the following ORBIT scores:
0-2
3
4-7
0-2 low bleeding risk
3 medium
4-7 high bleeding risk
what drugs are used in RATE control AF [1st line]?
DI2 VE BETA
dilitiazem
digoxin
verapamil
beta blockers [not sotalol]
when is digoxin monotherapy for rate control AF considered? [4]
only when pt does little to no exercise
when all other rate limiting drugs were unsuccessful
those with congestive heart failure
those suffering with NON paroxysmal AF
what can you consider if monotherapy for rate control AF fails?
dual therapy with BB DD:
beta blockers
diltiazem
digoxin
what must you consider if a patient fails to have controlled AF with rate control monotherapy and dual therapy?
rhythm control strategy
which is 1st line treatment for AF: rhythm or rate control
rate
rate control is 1st line treatment in AF except in which types of people? [5]
- ppl with new onset AF
- ppl with atrial flutter suitable for surgery
- ppl with a reversible cause of their AF [eg MI, hyperthyroidism]
- ppl who have heart failure originally thought to be caused by AF
- ppl who rhythm control strategy would be better
what drug class must you AVOID in heart failure and AF?
calcium channel blockers
what is the 1st line treatment for rhythm control in AF?
beta blockers not sotalol
what is the 2nd line treatment options for rhythm control in AF?
consider flecainide , amiodarone, sotalol, propafenone and dronedarone
rhythm control
which 2 drugs must be AVOIDED in people with ischaemic or structural heart disease?
flecainide and propafenone
rhythm control
which drug should be CONSIDERED for people with heart failure or left ventricular impairment?
amiodarone
when should ELECTRICAL cardioversion be considered?
when AF has been present for more than 48 hours
what kinds of treatment should the patient be on before electrical cardioversion is attempted?
what is the alternative if this is not possible?
anticoagulants 3 weeks before electrical cardioversion bc risk of stroke
alternative: heparin just before
what 2 medications MUST a patient be given after electrical cardioversion and for how long?
oral anticoagulants for at least 4 weeks after
amiodarone to control sinus rhythm
what is acute atrial fibrilation?
someone who has just had a new onset AF less than 48 hours
what is the treatment for a patient with new onset AF and life threatening haemodynamic [abnormal BP and heart rate]?
emergency electrical cardioversion
what should patients with NON life threatening haemodynamic instability be offered?
rate or rhythm control if arrythmia occurred LESS than 48 hours
rate control if arrythmia occurred more than 48 hours or unsure how long they had it
what should be offered to a patient with new onset AF who are receiving no oral anticoagulation yet?
parenteral anticoagulant eg heparin
which oral anticoagulants are 1st line recommended for patients with AF?
what should be given if this is contraindicated eg pt has renal impairment?
DOAC first line
vitamin K antagonists second line eg warfarin
what drugs should be used to treat supraventricular arrythmias? [3]
verapamil
cardiac glycosides eg digoxin
adenosine
which drugs should be used to treat ventricular arrythmias? [2]
lidocaine
sotalol
which drugs should be used to treat supraventricular and ventricular arrythmias [2]
amiodarone
beta blockers