B4-001 Big Case: Tachycardia Flashcards
maximum predicted HR
220-patients age
3 consecutive beats greater than >100 bpm
tachycardia
sequence of excitation in the heart
- SA node
- atrial muscle
- AV node
- common bundle
- bundle branches
- purkinje fibers
- ventricular muscle
what could a narrow QRS indicate?
- atrial tissue only
- sinus tachycardia
what could a wide QRS indicate?
- ventricular tachycardia
- any narrow complex tachycardia with aberrant conduction
irregularly irregular without P waves
atrial fibrillation
most common sustained arrhythmia, increases with age
a fib
cardiac causes of a-fib
- hypertension
- CAD
- heart failure
- cardiomyopathy
- valvular disease
- arrhythmias
non-cardiac causes of a-fib
- sleep apnea
- obesity
- hyperthyroidism
- drugs
- electrocution
- pneumonia
- pulmonary embolism
- alcohol (holiday heart syndrome, dose dependent)
“A-fib begets a-fib”
progression of a-fib
paroxysmal, persisent, longstanding persistent, permanent
what studies should always be done to evaluate a-fib?
- 12 lead ECG
- labs
- TTE
causes of valvular atrial fibrillation
3
- rheumatic mitral stenosis
- moderate-to-severe mitral stenosis
- mechanical valve
ABCs of A-fib management
A: anticoagulation/avoid stroke
B. better symptom control
C. cardiovascular risk factors and comorbidities
score system used to evaluate risk of thromboembolism
CHA2DS2-VASc
score system to evaluate risk of bleeding
HAS-BLED
most concerning complication of a-fib?
increased stroke risk
from blood pooling and forming clots
most concerning complication of a-fib?
increased stroke risk
from blood pooling and forming clots
patients with a-fib have an increased risk of?
[4]
- ischemic stroke (5x)
- heart failure (3x)
- dementia (2x)
- death (2x)
why are a-fib related strokes worse than other strokes?
- increased 30 day mortality (almost 2x)
- more likely to recur
- more severe functional deficits
oral anticoagulation is strongly recommended for a CHA2DS2-VASc score greater than
- 2 for men
- 3 for women
factors that have a CHA2DS2-VASc value greater than 2
2
- age >75
- hx of stroke, TIA, or embolism
HAS-BLED score greater than 3
- warrants additional monitoring
- address modifiable bleeding risks
modifiable bleeding risks
5
- uncontrolled hypertension
- abnormal renal function
- labile INR (<60% in therapuetic range)
- antiplatelets or NSAID use
- greater than 8 drinks per week
only anticoagulation for valvular a-fib
warfarin
oral direct thrombin inhibitor
dabigatran
oral direct Xa inhibitor
3
- rivaroxaban
- apixaban
- endoxaban
lowest conduction velocity in heart
SA and AV node
fastest conduction velocity in heart
purkinje fibers
MAP=
COxTPR
CO=
HRxSV
SV=
EDV-ESV
MAP
mean arterial pressure
CO
cardiac output
TPR
total peripheral resistance
HR
heart rate
SV
stroke volume
preload
contractibility
afterload
SV
stroke volume
preload
contractibility
afterload
EDV
end diastolic volume
ESV
end systolic volume
rate or rhythm control?
- beta blockers
- non-dihydropyridine calcium channel blockers
- cardiac glycoside
- amiodarone
rate
IV beta blockers
3
- metoprolol
- tartrate
- esmolol
PO beta blockers
- metoprolol succinate
- bisoprolol
- carvedilol
- atenolol
non-dihydropyridine calcium channel blockers
2
- diltiazem
- verapamil
both IV and PO
non-dihydropyridine calcium channel blockers
2
- diltiazem
- verapamil
both IV and PO
cardiac glycoside that is not first line and not monotherapy
digoxin
used for critically low pressures or acute heart failure
amiodarone
