Cardiovascular- arrhythmias Flashcards
What are the aims of AF treatment?
To reduce symptoms and prevent complications, especially stroke
What are the 2 methods for managing AF?
Rate and rhythm control
How often should you review anticoagulation, stroke and bleeding risk in AF patients?
Annually
What should patients have if they present with acute life threatening haemodynamically unstable AF?
Electrical cardioversion
What management for AF is preferred if onset is more than 48 hours
rate control
What is used for pharmacological cardioversion?
IV amiodarone or fleicanide
How long should you anticoagulate someone before cardioversion? and after?
at least 3 weeks. if not possible then start parenteral anticoagulation. at least 4 weeks after
What drugs are used for rate control?
Beta blocker or a rate limiting CCB (dilitiazem or verapamil as monotherapy)
Who should have digoxin as monotherapy?
predominantly sedentary patients with non-paroxysmal AF (as only effective for controlling the ventricular rate at rest)
What do you do if a single drug fails to control ventricular rate in AF?
use a combination of two drugs; beta-blocker, digoxin, diltiazem
What is the first choice for rhythm control?
standard beta blocker
What is second choice for rhythm control?
oral anti-arrhythmic drug- sotalol, fleicanide, propafenone, amiodarone
what can be used to increase the success of electrical cardioversion?
amiodarone started 4 weeks before and 12 months after
What shouldn’t be given for AF is there is known ischaemic or structural heart disease?
fleicanide or propafenone
What do you use for paroxysmal AF?
standard beta blocker. if symptoms persist give an oral anti-arrhythmic
What is the ‘pill in the pocket’ approach?
patient takes oral flecainide or propafenone when AF occurs
What is CHA2DS2-VASc?
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
What does the CHA2DS2-VASc score tell us?
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
What is HAS-BLED?
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
How do you treat atrial flutter?
rate or rhythm control. responds less well than AF to drugs
What is Torsade de pointes?
ventricular tachycardia associated with a long QT syndrome. Can give IV Mg. Anti-arrhythmics can worsen.
What are the Vaughan Williams classifications of anti-arrhthymic drugs?
Class 1- membrane stabilising drugs i.e. lidocaine, flecainide
Class 2- beta blockers
Class 3- amiodarone, sotalol
Class 4- CCB
What do you need to monitor with IV flecainide?
ECG. Resus facilities must be available
What is the half life of amiodarone?
long- potential for drug interactions to occur several weeks or even months after treatment stopped. Avoid concomitant use of drugs that prolong QT interal
