cardio Flashcards
1st line investigations af
-12 lead ecg (diagnostic)
-TTE (identify abnormalities which may affect management)
proximal ag= holter monitor (continuous ecg 24-72hours)
broad managent acute AF
<48 hours- rate or rhythm control
48 hours or >/ uncertain= rate control
-if considered for rhythm control, delay cardioversion until they have been maintained on therapeutic anticoagulation <3 weeks
medication rate control AF
1st= beta blockers
2nd= CCB
3rd= Digoxin
rhythm control medications AF
1st= beta blockers
2nd= dronedarone (helpful following cardioversion)
Amiodarone if coexisting HF
who is Rate control offered not offered to first line?
-Af presenting <48 hours
-Rhythm control been ineffective
-Reversible cause of AF
- HF caused by AF
-Atrial flutter
Af + haemodynamically unstable
immediate synchronised cardioversion
AF for years, symptoms continue + tried BB, CCB + digoxin
delayed cardioversion
-anticoagulate for 3 weeks prior +/- BB
medication that may be used for rhythm control?
-Fleicanide or amiodarone
choose amiodarone if evidence of structural heart disease
what may be offered to people with paroxysmal AF
May be suitable for the ‘Pill in pocket’ using Flecainide
Must have infrequent episodes WITHOUT structural heart disease + be able to identify the signs of AF and understand when to take treatment
what may be offered to those with AF who have not responded to or wish to avoid, antiarrhythmic medication
Catheter ablation:
1st= Left atrial ablation
2nd= AV node ablation + pacemaker
VF management
begin chest compressions (30:2)
witnessed/ being monitored in coronary care unit initial= 3 shocks
unwitnessed= 1 shock
Repeat shock 3x
After 3rd shock + chest compressions have restarted - give 300mg amiodarone IV + 1mg adrenaline IV
continue 1mg adrenaline every 3-5 mins
after 5th shock= 150mg amiodarone IV
(alternative to amiodarone= lidocaine)
what are shockable rhythms?
pulseless VT+ VF
most common cause mitral stenosis
rheumatic fever
falling BP
Rising JVP
Muffled heart sounds
management
Becks triad= cardiac tamponade
Urgent pericardiocentesis
malignancy= Percutaneous balloon pericardiotomy
pulse seen in cardiac tamponade
pulsus paradoxus
-large drop in pulse during inspiration
JVP cardiac tamponade vs constrictive pericarditis
contrictive pericarditis
-Y + X present
cardiac tamponade
-absent Y descent
what is a non shockable rhythm?
pulseless electrical activity/ asystole
-PEA
push early adrenaline (1mg adrenaline ASAP
