Cardiac Arrhythmias

Question 1

Cardiac Arrhythmias

Any variation in the normal heartbeat (disturbances in rate, rhythm, conduction pattern)

Causes: primary caridovascular disorders, pulmonary disorders (embolism), systemic disorders, drugs, electrolyte imbalance

Symptoms: slow/fast HR, irregular rhythm, palpitations, fatigue, dizziness, syncope, angina, CHF (SOB, peripheral edema)

Answer 1

Atrial fibrillation most common

• tx: Coumadin (INR 2-3 target)

Ventricular fibrillation #1 cause of sudden cardiac death

• caused by ischemia, cardiomyopathy, drug toxicity, sepsis

Premature Ventricular Complexes PVC

• highly symptomatic but not associated with adverse outcome

Question 2

Medical Management

Coumadin: Afib, prevent thrombosis.embolism (INR target 2-3)

Antiarrhythmic Drugs Class 1-4

1. Sodium channel blockers Quinidine
2. Beta blockers Propranolol
3. Potassium channel blockers Amiodarone
4. Calcium channel blockers Verapamil, Diltiazem

K+ channel blockers: prolong action potential, refractoriness

Pacemakers

Answer 2

Dental Management

Pacemakers:

• ABx prophy not needed
• EPT, EAL safe. Ultrasonic/electrosurgery devices poss. interferences

Abx: may interact with coumadin –> inrease INR (incr bleed)

EPI: 2 carp ok

Anxiety: BNZ, N2O

Bleeding: INR 2-3.5 OK surgery

Chair: orthostatic hypotension

Drugs: _Digoxin (_avoid EPI). Toxicity = hypersalivation, visual changes