Cardiac - arrhythmia, AF Flashcards
Arrhythmia
Classification by origin of depolarization
Arrhythmia
Classification by QRS complex
Interpret
Interpret
Interpret
Interpret
Interpret
Interpret
Narrow complex tachycardia
Diagnostic flowchart
Wide complex tachycardia
Diagnostic flowchart
LBBB vs RBBB
ECG features
Arrhythmia
First line management
Anti-arrhythmics
Classes
Example
MoA
Useage
Stable regular narrow complex tachycardia
Treatment
Stable wide complex tachycardia
Treatment
Vagal maneuver
MoA
S/E
C/I
ATP
MoA
S/E
C/I
Atrial flutter/ atrial fibrillation
Management
Outline risk stratification score for thromboembolic risk - CHA2DS2-VASc score
Sinus tachycardia
Management
Atrial tachycardia
AVRT
AVNRT
Management
Multifocal atrial tachycardia
Management
Wide complex tachycardia: VT, SVT with BBB, unknown type
Treatment
Bradycardia
Types
Heart block
ECG findings of 1st, 2nd, 3rd degree heart block
Heart block causes
1st and 2nd degree
Acute MI
Ischemic heart disease
Acute rheumatic heart disease
Myocarditis
Hypo-K+
Digoxin toxicity
β-blockers treatment
3rd degree
Acute MI
Aortic stenosis
Fibrosis around bundle of His
LBBB + RBBB
RBBB
ECG features
Causes
LBBB
ECG features
Causes
Left anterior hemi-block
ECG features
Bifascicular block
ECG feature
Sick sinus syndrome
ECG features
Bradycardia
First line management
Ventricular fibrillation/ Pulseless VT
Management
Pulseless electrical activity
Causes
Management
Outline primary CDAB and secondary ABCD surveys for VF, Pulseless VT, PEA, asystole
Asystole
Management
AF
Classification
AF
Causes
AF
D/dx
AF
Pathogenesis
AF
Clinical manifestations
AF
Investigation
AF
Treatment approaches
AF
Rate control drug choices
Target HR control
Pharmacological rate control
Target heart rate control
- Symptomatic: Resting HR < 80 bpm
- Asymptomatic + LVEF > 40%: HR < 110 bpm
- Note that rate-control strategy is not indicated if the AF has a slow HR originally
ABCD medications
- β-blockers»_space; non-dihydropyridine CCB, digoxin, and amiodarone
AF
Rate control drugs
- MoA
- Examples
- Contraindications
AF
Non-pharmacological rate control
Indication
AF
Anti-arrhythmics - Class Ic
- Examples
- MoA
- C/I
- S/E
AF
Anti-arrhythmics - Class III Amiodarone
- MoA
- C/I
- S/E
AF
Anti-arrhythmics - Class III Dronedarone
- MoA
- C/I
- S/E
Removal of iodine molecule causes less thyroid and systemic side effects compared to amiodarone, but less effective
Iodine also causes fat binding and increases half life of amiodarone
AF
Anti-arrhythmics - Class III Ibutilide, Dofetilide, Sotalol
- MoA
- C/I
- S/E
Choice of class III anti-arrhythmics in AF with:
- No heart disease
- Post-MI/ CAD
- Heart failure
- Hypertension with LVH
AF
Non-pharmacological rhythm control options
Direct-current (DC) cardioversion (Electrical cardioversion)
Catheter ablation:
- Indicated in patients with symptomatic paroxysmal/ persistent/ long-standing persistent AF who are refractory or intolerant to ≥ 1 Class I or III anti-arrhythmic drugs
- radiofrequency ablation (RFA) and cryoballoon (cryothermal) ablation
- Most common pulmonary vein isolation technique is circumferential pulmonary vein isolation (PVI)
- Anticoagulation is indicated to prevent thromboembolism around the time of RFA
- Complications include cardiac tamponade (most common), stroke, TIA or pulmonary vein stenosis
Surgical maze procedures (Surgical ablation)
- Indicated in selected patients undergoing other cardiac surgery e.g. valvular replacement or CABG
- radiofrequency or cryothermal energy (Cox-Maze IV procedure)
- create a “maze” of functional myocardium within the atrium
Direct-current (DC) cardioversion (Electrical cardioversion)
Indications
Anticoagulant timing
S/E
Indications
o Hemodynamically unstable patients
o Refractory to pharmacological cardioversion
o Rapid control of ventricular rate during AF is required (preferred over pharmacological cardioversion in patients with decompensated HF, ongoing myocardial ischemia, or hypotension)
AF
Prevention of thromboembolism
- Indication
- Risk stratification
- Drug choices
Choice of antithrombotic options
Options = Warfarin/ Dabigatran/ Rivaroxaban/ Apixaban
Aspirin + Clopidogrel (Dual anti-platelet therapy) – Less effective
- Indicated in patients who refuse or contraindicated to anticoagulants
Aspirin alone – Even less effective
- Indicated in patients who refuse or contraindicated to anticoagulants
AF
Warfarin
- Target INR
- MoA
- Indication
- Contraindicaton
AF
Direct anticoagulant
* Drug types
* Indication
* Contraindication
* MoA
AF
Thromboembolism prevention
Compare NOAC vs Warfarin
- Efficacy
- Safety
- Advantage of NOAC
- Disadvantage of NOAC
AF
Bridging therapy
- Indication
- Drug choice
AF
Non-pharmacological prevention
