Atrial flutter Flashcards
atrial fibrillation what is it
disorganised abnormal heartbeat by electrical signals being fired rapid and irregular
symptom af and complications
dizzy tired sob - floppy fish in chest
complication; stroke and HF
types of AF ;
paroxysmal
persistent
permanent
paroxysmal = stops in <48hrs
permanent= all the time
persistent >7 days
offer aspirin as mono therapy in AF for stroke prevention ?
no
1st line AF maintenance?
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
dual therapy can you do verapamil and beta blocker
no avoid this mix of rate limit ccb ad beta blocker
what to do in decreased LVEF and AF
for dual therapy give beta blocker and digoxin (never ccb rate limit as c/I in HF)
rules of maintenance
mono therapy (rate) - dual therapy (rate) - (rhythm control)
rhythm control examples
amiodarone flueicanide, dronedarone, stall, propafenone
(also given if rhythm control required post cardio version)
what to do acute onset
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)
cardio version?
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
cardioversion if haemodynamically unstable
give electrical cardio version and parental anticoagulant but rule out left arterial thrombus before procedure
Atrial flutter tx
same as Afib but catheter ablation preferred
how to assess risk of stroke
and points to give oral anticoag
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
risk of stroke to risk of bleed
CHA2DS2VAS vs HAS BLED
IF stroke> give anticoagulant
what anticoagulant to give in new onset A fib (non acute) where symptoms might not present
parenteral anticoagulant
what anticoagulant to give in diagnosed af
warfarin or NOAC
give Noac if chadvasc ( >1 or equal to )
what is tordaes des point
ventricular arrhythmia that prolongs the qt
i.e. in drugs like sotalol , hypokalaemia and bradycardia
hypokalaemia drugs- DIBTC
DIBTC
hypokalaemia drugs: diuretics , insulin, beta 2 agonist, theophylline, corticosteroid
treat tornadoes des points
iv magnesium sulfate
ventricular arrhythmia tx acute
pulseless or fibrillation
unstable/ sustained
stable
non-sustained
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
ventricular tachycardia most likely to cause and maintenance tx
MI high risk
tx = sotalol, beta blocker, or beta blocker + amiodarone
paroxysmal ventricular supraventrivculat tachycardiawhat is it
terminate spontaneous or reflex vagal nerve stimulation
(straining on defecation-valsaval manueaouvre) , ice on face, carotid sinus massage)
tx of paroxysmal superventriculr tachycardia
what if haemodynamically unstable
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)
paroxysmal and symptomatic afib tx
1)ventricular or rhythm control
2)infrequent episode
1) standard beta blocker or oral antiarryhtmic
2) infrequent= pill in pocket ,fleicainide or propafenone self tx restore sinus rhytm
