Atrial flutter

Question 1

atrial fibrillation what is it

Answer 1

disorganised abnormal heartbeat by electrical signals being fired rapid and irregular

Question 2

symptom af and complications

Answer 2

dizzy tired sob - floppy fish in chest
complication; stroke and HF

Question 3

types of AF ;
paroxysmal
persistent
permanent

Answer 3

paroxysmal = stops in <48hrs
permanent= all the time
persistent >7 days

Question 4

offer aspirin as mono therapy in AF for stroke prevention ?

Answer 4

no

Question 5

1st line AF maintenance?

Answer 5

rate control (reduce HR)
ex: 1st line beta blocker (not sotalol)
2)CCB rate limit (diltiazem or verapamil) dont use in HF tho
3) digoxin (more so form permanent/ persistent) used digoxin in sedentary patients

Question 6

dual therapy can you do verapamil and beta blocker

Answer 6

no avoid this mix of rate limit ccb ad beta blocker

Question 7

what to do in decreased LVEF and AF

Answer 7

for dual therapy give beta blocker and digoxin (never ccb rate limit as c/I in HF)

Question 8

rules of maintenance

Answer 8

mono therapy (rate) - dual therapy (rate) - (rhythm control)

Question 9

rhythm control examples

Answer 9

amiodarone flueicanide, dronedarone, stall, propafenone

(also given if rhythm control required post cardio version)

Question 10

what to do acute onset

Answer 10

life threatening haemodynamic instability: give electrical cardio version

no life threatening instability;
<48hr give rhythm or rate control (electrical or amiodarone/fleicanide)
>48hr give rate control (verapamil or beta blocker)

Question 11

cardio version?

Answer 11

restore sinus rhythm
1) pharmacological = anti arrythmics
2) electric = direct current

cannot give pharmacological if >48hrs need electrical due to inc stroke risk

give pharmacological- wait until fully anticoagulant 3 weeks before cardio version and continue 4 weeks after

Question 12

cardioversion if haemodynamically unstable

Answer 12

give electrical cardio version and parental anticoagulant but rule out left arterial thrombus before procedure

Question 13

Atrial flutter tx

Answer 13

same as Afib but catheter ablation preferred

Question 14

how to assess risk of stroke
and points to give oral anticoag

Answer 14

CHA2DS2VAS
chronic hf or lv dysfunction = 1point
hypertension = 1 point
age= 75+ = 2
dm=1
stroke / TIA/vte = 2
vascular disease= 1
Age65-74=1
s= sex catergory i.e female= 1

2 or more points = oral anticoagulant

Question 15

risk of stroke to risk of bleed

Answer 15

CHA2DS2VAS vs HAS BLED
IF stroke> give anticoagulant

Question 16

what anticoagulant to give in new onset A fib (non acute) where symptoms might not present

Answer 16

parenteral anticoagulant

Question 17

what anticoagulant to give in diagnosed af

Answer 17

warfarin or NOAC
give Noac if chadvasc ( >1 or equal to )

Question 18

what is tordaes des point

Answer 18

ventricular arrhythmia that prolongs the qt
i.e. in drugs like sotalol , hypokalaemia and bradycardia
hypokalaemia drugs- DIBTC

Question 19

DIBTC

Answer 19

hypokalaemia drugs: diuretics , insulin, beta 2 agonist, theophylline, corticosteroid

Question 20

treat tornadoes des points

Answer 20

iv magnesium sulfate

Question 21

ventricular arrhythmia tx acute
pulseless or fibrillation
unstable/ sustained
stable
non-sustained

Answer 21

1)give defibrillator and CPR with refractory iv amiodarone
2) direct current cardio version. if fails iv amiodarone and another direct
3) stable= antiarrythmic iv (amiodarone prefer)
4) non sustained= beta blocker

Question 22

ventricular tachycardia most likely to cause and maintenance tx

Answer 22

MI high risk
tx = sotalol, beta blocker, or beta blocker + amiodarone

Question 23

paroxysmal ventricular supraventrivculat tachycardiawhat is it

Answer 23

terminate spontaneous or reflex vagal nerve stimulation
(straining on defecation-valsaval manueaouvre) , ice on face, carotid sinus massage)

Question 24

tx of paroxysmal superventriculr tachycardia
what if haemodynamically unstable

Answer 24

IV adenosine (c/I in asthma or cold)
give iV verapamil

give electrical cardio version of haemodynamic unstable
- recurrent= catheter ablation or anti arrhythmic drugs (felicainide, propafenone, beta blocker, verapamil, diltiazem)

Question 25

paroxysmal and symptomatic afib tx
1)ventricular or rhythm control
2)infrequent episode

Answer 25

1) standard beta blocker or oral antiarryhtmic
2) infrequent= pill in pocket ,fleicainide or propafenone self tx restore sinus rhytm