Atrial Arrhythmias Flashcards
What is a supraventricular arrhythmia?
An arrhythmia that occurs above the bundle of his
What types of arrhythmias require drug treatment?
- PSVT
- automatic atrial tachycardias
- afib/aflutter
What is a PSVT?
AV nodal reentry arrhythmia
What are the symptoms of PSVT?
- episodes of rapid HR
- abruptly start and stop
- syncope, chest or neck pressure
What is the severe symptom of PSVT?
HR > 200 bpm
What do you do to correct severe PSVT?
synchronized DCC
What do you try first to treat mild-moderate PSVT?
non-pharm treatments
- unilateral carotid massage
- valsalva maneuvers
- induced retching
- ice water facial immersion
What happens if the non-pharm treatments of mild-moderate PSVT fail?
Use drug treatment
What are the drug treatments for mild-moderate PSVT?
- adenosine IV push
- verapmil slow IV push
- diltiazem slow IV push
What is the MOA for adenosine, verapamil, and diltiazem?
Prolongs conduction time in slow anterograde pathway of the reentrant loop to terminate PSVT
What are the interactions with diltiazem and verapamil?
3A4 inhibitors - be careful with statins, HIV meds, and benzos
What is another way to treat PSVT other than long-term chronic drug therapy?
transcutaneous catheter ablation using radiofrequency currents
What is an automatic atrial tachycardia?
a supraventricular foci with enhanced automatic properties
What is often the underlying cause of automatic atrial tachycardias?
Severe pulmonary disease
What also causes automatic atrial tachycardias?
- acute infection
- sepsis
- dilated congestive cardiomyopathy
How do you treat automatic atrial tachycardias?
Correct the underlying factors (proper oxygenation and correct acid/base/electrolyte disorders)
How can you treat a symptomatic patient with automatic atrial tachycardias?
1st line: verapamil, diltiazem
2nd line: IV magnesium (high doses)
What is the most common arrhythmia seen in practice?
Atrial fibrillation
What leads to higher rates of afib?
- Worsening HF symptoms
- Male
- Caucasians
What is a common outcome of afib?
Not mortality –> Stroke!
What cardiovascular conditions is afib usually associated with?
- HF
- mitral valve disease
- CAD
- HTN
- Diabetes
What are the common acute causes of afib?
- MI or cardiac surgery
- Hyperthyroidism
- PE
- Pericarditis
- Alcohol intake
What is paroxysmal afib?
AF that terminates within 7 days of onset
What is persistent afib?
Continuous afib that is sustained for more than 7 days and does not terminate on its own
What is permanent afib?
Does not terminate with cardioversion or when the patient and doctor agree to stop trying to restore SR
What is acute afib?
onset within last 48 hours
What is recurrent afib?
2 or more episodes (either paroxysmal or persistent afib)
What is lone afib?
<60 years of age, without evidence of cardiopulmonary disease
What is aflutter?
single dominant reentrant substrate
What does AF do to CO?
It decreases CO and leads to an irregularly irregular rhythm
What are the common symptoms of afib patients (if they are even symptomatic)?
- palpitations
- rapid HR
- worsening HF
- fatigue
- chest pain
- syncope
What is a transthoracic ECHO used for?
To assess valve function, chamber size, and hypertrophy
What is a transesophageal ECHO used for?
to screen for left atrial thrombus
What test should you order for AF?
- EKG
- ECHO (TTE and TEE)
- Thyroid tests
- Electrophysiological study
What are the goals of management of AF?
- evaluate need for acute treatment
- achieve ventricular rate control
- need for SR restoration and maintenance
- prevent long-term complications (thromboembolism)
- prevent recurrence
How do you determine if patient is hemodynamically unstable?
- VR > 110
- Severe hypotension, pulmonary edema, or acute
MI
What do you do with a hemodynamically unstable patient?
DCC (shock)
What energy level is used for shock of atrial flutter?
50 joules
What energy level is used for shock of afib?
> 200 joules
How do you select a drug to control ventricular rate?
Left ventricular function
What do you use when LVEF > 40%?
- IV beta-blockers (metoprolol, propranolol, esmolol)
2. IV diltiazem, IV verapamil
What do you use when LVEF < 40%?
- IV digoxin
2. IV amiodarone
When do you use rate control?
In patients who are not symptomatic
What is the maintenance rate control goal?
HR < 110 bpm according to RACE II trial
