CVS - Arrhythmias

Question 1

What do you treat in acute new onset A.Fib that was less than 48hrs

Answer 1

Rate or Rhythm control
Rate = BB or Verapamil
Rhythm = Electrical or Amiodarone or Flecainide

Question 2

What do you treat in acute new onset A.Fib that’s over 48hrs

Answer 2

Rate control preferred

BB or Verapamil

Question 3

What is the Maintenance drug treatment for confirmed A.Fib

Answer 3

1st Line = Monotherapy Rate Control
BB, Verapamil, Diltiazem (unlicensed);
**Digoxin - if above not suitable or sedentary

2nd Line = Dual Therapy
Combine any of the two above (NOT verapamil)

3rd Line = Rhythm Control
BB or Anti-arrhythmics e.g.
Sotalol, Amidarone, Flecainide, Profenone, Dronedarone

Question 4

What drug is commonly used for the ‘Pill-in-the-pocket’ approach?

Answer 4

Flecainide

or any anti-arrhythmic drug

Question 5

What does CHA2DS2VASc stand for

Answer 5

Congestive heart failure = 1
Hypertension = 1
Age >75 = 2
Diabetes = 1
Stroke/TIA = 2
Vascular disease = 1
Age 65-74 = 1
Sex (female) = 1

Question 6

Based of the CHA2DS2VASc tool when would you offer anticoagulant therapy

Answer 6

• Offer for scores of 2 or more
• Consider offering in men with scores of 1 or more
• Stroke risk must outweigh bleeding risk

Question 7

What anticoagulant would you use following the use of the CHA2DS2VASc tool

Answer 7

DOAC
e.g. Apixaban, Edoxaban, Rivaroxaban and Dabigatran

If unsuitable or contra-indicated offer Warfarin

Question 8

What are the classes of anti-arrhythmic drugs and what channels do they block?

Answer 8

Class 1: Na+ (Flecainide; lidocaine)
Class 2: Beta (beta-blockers)
Class 3: k+ (amiodarone; sotalol)
Class 4: Ca2+ (rate limiting CCB e.g. Verapamil)

Question 9

How does Amiodarone work

Answer 9

Even though its class 3, it actually works in all the classes by blocking the channels/recpetors

Question 10

What are the Key Side Effects of Amiodarone (5)

Answer 10

1. Corneal Deposits
2. Hepatoxicity
3. Hyper/Hypo-thyroidsm
4. Pulmonary Toxicity
5. Photosensitivity

Question 11

Amiodarone treats arrhythmias and therefore cannot cause it? True or False

Answer 11

False - it can cause arrhythmias because it blocks all the channels meaning we could affect the heart too much/in ways not intended to

Question 12

What Monitoring is required when using Amiodarone? (6)

Answer 12

1. LFT - before and every 6 months
2. TFT -before, every 6 months and several months after stopping
3. Serum K+ - before
4. Chest x-ray - before
5. ECG (iv)
6. Consider Eye test

Question 13

What counselling points are important when taking amiodarone? (5)

Answer 13

1. Carry an alert card
2. Wear high SPF and shield skin during and after treatment
3. Caution with driving and skilled task bc corneal deposits
4. Seek medical advice if SOB to new cough develops during or after treatment
5. Signs of hepatotoxicity: Jauandice, Abdominal pain; Nausea/vomiting, Bruising