Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pre reg > Cardiovascular- arrhythmias > Flashcards

Cardiovascular- arrhythmias Flashcards

1
Q

What are the aims of AF treatment?

A

To reduce symptoms and prevent complications, especially stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 2 methods for managing AF?

A

Rate and rhythm control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How often should you review anticoagulation, stroke and bleeding risk in AF patients?

A

Annually

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What should patients have if they present with acute life threatening haemodynamically unstable AF?

A

Electrical cardioversion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What management for AF is preferred if onset is more than 48 hours

A

rate control

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is used for pharmacological cardioversion?

A

IV amiodarone or fleicanide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How long should you anticoagulate someone before cardioversion? and after?

A

at least 3 weeks. if not possible then start parenteral anticoagulation. at least 4 weeks after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What drugs are used for rate control?

A

Beta blocker or a rate limiting CCB (dilitiazem or verapamil as monotherapy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Who should have digoxin as monotherapy?

A

predominantly sedentary patients with non-paroxysmal AF (as only effective for controlling the ventricular rate at rest)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do you do if a single drug fails to control ventricular rate in AF?

A

use a combination of two drugs; beta-blocker, digoxin, diltiazem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the first choice for rhythm control?

A

standard beta blocker

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is second choice for rhythm control?

A

oral anti-arrhythmic drug- sotalol, fleicanide, propafenone, amiodarone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what can be used to increase the success of electrical cardioversion?

A

amiodarone started 4 weeks before and 12 months after

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What shouldn’t be given for AF is there is known ischaemic or structural heart disease?

A

fleicanide or propafenone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What do you use for paroxysmal AF?

A

standard beta blocker. if symptoms persist give an oral anti-arrhythmic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the ‘pill in the pocket’ approach?

A

patient takes oral flecainide or propafenone when AF occurs

17
Q

What is CHA2DS2-VASc?

A

Calculates stroke risk:

  • Congestive HF= 1
  • Hypertension= 1
  • Age >=75= 2
  • Diabetes= 1
  • Previous stroke/TIA/VTE= 1
  • Vascular disease= 1
  • Age 65-74= 1
  • Sex female= 1
18
Q

What does the CHA2DS2-VASc score tell us?

A

Low score 0 for men or 1 for women do not need anti-coagulating. Offer anticoagulation to those whose risk of stroke outweighs the risk of bleeding

19
Q

What is HAS-BLED?

A

Risk of bleeding.

  • Hypertension= 1
  • Abnormal liver or renal function= 1
  • Stroke= 1
  • Bleeding= 1
  • Labile INR= 1
  • Elderly (>65)= 1
  • Drugs= 1
  • Alcohol=1
20
Q

How do you treat atrial flutter?

A

rate or rhythm control. responds less well than AF to drugs

21
Q

What is Torsade de pointes?

A

ventricular tachycardia associated with a long QT syndrome. Can give IV Mg. Anti-arrhythmics can worsen.

22
Q

What are the Vaughan Williams classifications of anti-arrhthymic drugs?

A

Class 1- membrane stabilising drugs i.e. lidocaine, flecainide
Class 2- beta blockers
Class 3- amiodarone, sotalol
Class 4- CCB

23
Q

What do you need to monitor with IV flecainide?

A

ECG. Resus facilities must be available

24
Q

What is the half life of amiodarone?

A

long- potential for drug interactions to occur several weeks or even months after treatment stopped. Avoid concomitant use of drugs that prolong QT interal

25
Q

What are the side effects of amiodarone?

A
  • Corneal Microdeposits- rarely interfere with vision, but might cause dazzling at night.
  • Thyroid function- contains iodine and can cause both hypo or hyper-thyroidism.
  • Hepatotoxicity
  • Pulmonary toxicity
  • Peripheral neuropathy
26
Q

What monitoring is needed for amiodarone?

A
  • Thyroid function before and every 6 months
  • LFTs before and every 6 months
  • Potassium before
  • CXR before
27
Q

What advice should be given to patients taking amiodarone?

A

Protect skin from light

28
Q

What effect does sotalol have on the QT interval?

A

prolongs it and can cause ventricular arryhthmias, Correct K and Mg before sotalol and during use

29
Q

How do you treat life threatening digoxin toxicity unresponsive to atropine?

A

digoxin specific antibody fragments

30
Q

In AF what should the heart rate not be allowed to fall below?

A

60

31
Q

What is the most important determinant of digoxin dose?

A

renal function

32
Q

What range indicates digoxin toxicity?

A

1.5 to 3mcg/L. Need symptoms too

33
Q

What are the signs of digoxin toxicity?

A 
confusion
arrhyhthmias
loss of appetite
diarrhoea, vomiting, nausea
fast heartbeat
vision changes
34
Q

When do you measure digoxin levels?

A

only if toxicity is suspected

35
Q

Who should be careful of using digoxin

A

elderly- susceptible to digoxin toxicity

36
Q

What electrolyte imbalance predisposes to digoxin toxicity?

A

hypokalaemia- managed by giving a potassium sparing diuretic or if necessary potassium supplementation
hypomagnesaemia
hyperglycemia

37
Q

How does digoxin work?

A

cardiac glycoside- increased force of myocardial contractions and reduces conductivity in the AV node

Pre reg (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions