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