clinical tx of arrhythmia 3

Question 1

Tachyarrhythmias: Atrial Fibrillation- 5 C’s

Answer 1

1. Cause: Reverse
2. Control Rate
3. antiCoagulation
4. Control Rhythm
5. Cure: Ablation

Question 2

Common Causes of AF

Answer 2

1. Hypertension 14%
2. IHD
3. Mitral valve Disease
4. Alcohol
5. Cardiomyopathies
6. Hyperthyroidism
7. Lone AF: 14%

Question 3

Other causes of AF

Answer 3

1. Congenital Ht disease
2. Pulmonary embolism
3. Infection
4. Hypoxia
5. Cardiac surgery
6. Carditis
7. Ca Bronchus

Question 4

immediate AF treatment

Answer 4

1. Cardiovert
   ( Hemodynamic collapse)
2. Control the Rate
   (Assess symptoms)

Question 5

Rhythm Control (Cardioversion)

Answer 5

1. pharmacological
   a. less successful
   b. Does not require sedation
2. electrical
   a. DC Shock 70-90% successful
   b. Day procedure in hospital
   c. needs sedation

Question 6

drug used to control rhythm:

Answer 6

1. Class III agents-
   a. ibutilide
   b. amiodarone,
   c. dofetilide,
   d. sotalol
2. Class IC agents-
   a. flecainide,
   b. propafenone

Question 7

Rhythm Control (Maintenance)

Answer 7

1. Patients with recurrent AF may require long term maintenance medications to control rhythm, especially if they are symptomatic in AF.
2. Class IC agents – contraindicated in CAD and structural heart disease
3. Class III agents – amiodarone, sotalol, dofetilide, dronedarone.
4. Patients with a rhythm control agent should still be anticoagulated based on their risks for thromboembolism, as rhythm control is not a cure.

Question 8

Rate control: Medication

Answer 8

1. Betablockers
2. Digoxin
3. Verapamil
4. Diltiazem
5. Amiodarone can be used as a rate-controlling agent, especially in setting of decompensated heart failure.

Question 9

Rate control Digoxin

Answer 9

does not control rate during exercise very well

Question 10

Rate control: which are good for HR in exercise

Answer 10

1. Beta blocker

2. Ca antagonist

Question 11

Thromboembolic prophylaxis:

Answer 11

increased stroke risk in pt with certain risk factors

Question 12

when is catheter ablation used?

Answer 12

1. when people fail medications
2. rhythm control
3. target atrial fib–specifically in LA

Question 13

3 categories of other SVTs

Answer 13

1. AV nodal reentrant tachycardia
2. Accessory pathway-mediated tachycardias:
3. Focal atrial tachycardias:

Question 14

AV nodal reentrant tachycardia

Answer 14

(circuit within the AV node):

most common, accounts for ~65% of regular SVTs (not including AF/flutters)

Question 15

Accessory pathway-mediated tachycardias:

Answer 15

abnormal connection between atrium and ventricle.

Question 16

Focal atrial tachycardias:

Answer 16

least common, abnormal focus of atrial tissue with enhanced automaticity– a “hotspot”.

Question 17

Other SVTs: Treatment

Answer 17

1. Treatment individualized to the patient: risk/benefit analysis, patient preference.
2. Nonpharmacologic maneuvers:
3. Pill in pocket: Medication only with symptoms.
4. Long-term medication:
5. Catheter ablation

Question 18

Nonpharmacologic maneuvers: for other SVT

Answer 18

vagal maneuvers.

Question 19

Long term meds for other SVTs

Answer 19

1. beta blockers
2. calcium channel blockers to block AV node
3. Class I antiarrhythmics to suppress hotspots or premature beats that are triggers for tachycardia.

Question 20

catheter ablation in other SVT

Answer 20

1. cure > 90-95%
2. risks < 1%.
3. Guidelines recommend medications or ablation, depending on patient preference.

Question 21

Ventricular Tachyarrhythmias: acute tx if stable:

Answer 21

1. Medication like:
   amiodarone, lidocaine, procainamide
2. treat underlying causes

Question 22

Ventricular Tachyarrhythmias: acute tx if UNstable:

Answer 22

1. shock
2. treat underlying causes
3. medications