Cardiovascular Conditions: Arrythmias Flashcards by Patryk Lasiuk

Arrhythmia is,,,

an abnormal heart rhythm, causing heart to beat too slow or too fast

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Which node is the hearts pacemaker?

SA node

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When is QTc considered prolonged?

> 440ms, but usually > 500ms is worrying

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QT prolongation risk factors

Higher doses
Multiple QT prolonging drugs
Reduced drug clearance
Low potassium, mag, calcium
Other cardiac conditions
Female gender

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Class I anti arrhythmic drugs mechanism

Na-channel blockers

Reduces speed of ion conduction through sodium channels

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Class Ia, Ib, Ic

Double Quarter Pounder, Lettuce, Mayo, Fries, Please

Ia = DQP
Ib = LM
Ic = FP

D = disopyramide
Q = Quinidine
P = Procainamide
L = Lidocaine
M = Mexiletine
F = Flecainide
P = Propafenone

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Class II anti arrhythmic drugs

Beta blockers

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Class III anti arrhythmic drugs

K- channel blockers

D = Dronedarone
D = Dofetilide
S = Sotalol
I = Ibutilide
A = amiodarone

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Class IV anti arrhythmic drugs

non-DHP CA blockers

Diltiazem
Verapamil

**Dont use in HF and HFrEF **

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Paroxysmal AF

terminates spontaneously or with intervention within 7 days of onset

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Persistent AF

continuous AF > 7 days

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Long-standing Persistent AF

continuous AF > 12 months

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Permanent AF

clinician/patient cease further attempt to restore/maintain normal sinus rhythm

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Valvular AF

AF w/ moderate-severe mitral stenosis or with mech heart valve, long term warfarin anticoag indicated

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Non-valvular AF

AF w/o moderate-severe mitral stenosis or mech heart valve

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Rate control goals

resting HR < 80 BPM in symptomatic patients
resting HR < 110 BPM in asymptomatic w/ preserved left ventricular function

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Preferred rate control treatment?

BB
non-DHP (dont use in HFrEF)

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Rhythm control - Cardioaversion

High risk of thromboembolsim, zap the heart

pt should start anticoagulant 3 weeks before, and continue 4 weeks after
INR 2-3 if on warfarin

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Rhythm control - pharmacologic cardio aversion

amiodarone
dofetilide
flecainide
ibutilide
propafenone

Amiodarone Boxed warning

Pulmonary toxicity
Hepatotoxicity

Amiodarone Contraindications

Iodine hypersensitivity

Amiodarone Warnings

Hyper/Hypothyroidism (hypo is common)
optic neuropathy
photosensitivity (slate-blue skin discoloration)

Amiodarone Side effects

hypotension
bradycardia
corneal microdeposits
photosensitivity

Amiodarone monitoring

ECG
BP
HR
Electrolytes
LFTs Q 6 months
Thyroid function

Amiodarone 1/2 life

40 - 60 days

Common drug interactions amiodarone

digoxin = decrease digoxin by 50% warfarin = decrease warfarin by 30-50% no more than 20mg/day simvastatin no more than 40mg/day lovastatin Dont sue with sofosbuvir, can increase bradycardic effect

Digoxin contraindications

V. Fib

Digoxin monitoring

Digoxin lvls, 12-24hrs after dose

Digoxin toxicity

N/V loss of appetite blurred/double vision greenish-yellow halos bradycardia life threatening arrhythmias low potassium, mag, calcium inc risk of digoxin toxicity

Digoxin antidote

DigiFab

Disopyramide warnings and Side effects

Warnings: pro arrhythmic SE: anticholinergic effects

Quinidine take with or without food?

With food or milk to decease stomach upset

Quinidine warnings and Side Effects

Warnings: Proarrhythic, hemolysis risk (dont use in G6PD deficiency), can cause positive Coombs test SE: DILE, diarrhea, stomach ache Cinchonism (Quinidine OD) = tinnitus, hearing loss, blurred vision, headache, delirium

Procainamide boxed warnings

potentially fatal agranulocytosis monitor first 3 months long-term use leads to + ANA in 50% pts, can result in DILE (20-30% pts)

Procainamide Slow acetlyators

at risk for drug accumulation and toxicity fast acetylators can have subthereapeutic drug conc

Drug used for refractory VT and cardiac arrest?

Lidocaine injection

Propafenone Side effects

metallic taste

Dronedarone Boxed warnings

inc risk of death/stroke in HF pts or permanent AF

Dronedarone CI

concurrent use strong CYP3A4 inhib and QT prolonging drugs

Dronedarone warnings

Hepatic failure (esp first 6 months) pulmonary disease

Dronedarone SE

QT prolongation diarrhea

Sotalol dosing adjustments

CrCL < 60 = decrease frequency CrCl < 40 = depends on formulation

Ibutilide notes

correct hypokalemia and hypomagnesemia before use and throughout treatment with medication

Dofetilide boxed warning

initiated in setting of continuous ECG monitoring, assess CrCl for min 3 days, QT prolongation

Dofetilide CrCl adjustments

CrCl < 60 = decrease dose CrCl < 20 = contraindicated

Dofetilide is the anti arrhythmic drug of choice in

Heart failure