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BNF INTRODUCTIONS > INTRODUCTION TO ARRHYTHMIAS > Flashcards

INTRODUCTION TO ARRHYTHMIAS Flashcards

1
Q

Electrocardiography is esential in managing arrhythmias T/F

A

True

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2
Q

Management of an arrhythmia requires precise diagnosis of the type of arrhythmia T/F

A

True

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3
Q

If a patient had ectopic beats abdominal normal heart, what is the general management

A

Treatment is rarely required and reassurance will suffice
Beta blockers are safer than suppressant drugs

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4
Q

Treatment aims for atrial fibrillation

A

Reduce symptoms
Prevent complications especially stroke

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5
Q

Two approaches to managing atrial fibrillation

A

Rhythm control (restore and maintain sinus rhythm)
Rate control (controlling ventricular rate)

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6
Q

Ablation strategies are considered in atrial fibrillation when……

A

Drug treatment has failed

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7
Q

In A. Fib, referral is made within how many weeks when cardioversion and drug treatment fails

A

Within 4 weeks

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8
Q

All patients with life- threatening haemodynamic instability caused by new onset atrial fibrillation should undergo…….

A

Emergency cardioversion without delaying to achieve anticoagulation

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9
Q

In A. Fib patients without life- threatening haemodynamic instability, what approach is preferred when onset is less than 48 hours and when onset is nore than 48 hours

A

<48 hours - rate or rhythm control
>48 hours or uncertain - rate control

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10
Q

Drugs used when urgent rate control is needed in A. Fib acute presentation

A

IV Beta blockers

Rate limiting -CCB( eg. Verapamil if LVEF is 40 or more)

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11
Q

Methods of cardioversion

A

Pharmacological
Electrical

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12
Q

Is cardioversion a rhythm or rate control strategy

A

Rhythm control strategy

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13
Q

Drugs for pharmacological cardioversion

A

Flecainide
Amiodarone

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14
Q

Among amiodarone and flecainide, which cannot be used in structural or ischemic heart disease patients

A

Flecainide is not used but Amiodarone is used

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15
Q

When is electrical cardioversion preferred to chemical

A

When atrial fibrillation has been present for more than 48 hours

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16
Q

How long should a patient be anticoagulated before electrical cardioversion

A

At least 3 weeks

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17
Q

How long is anticoagulation done after cardioversion

A

Right after cardioversion and continued for at least 4 weeks

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18
Q

If anticoagulation for 3 weeks before electrical cardioversion isn’t possible, what should be done

A

Rule out a left thrombus
Give a parenteral anticoagulation (heparin) immediately before cardioversion

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19
Q

Prior to cardioversion, patients should not be on rate control therapy. T/F

A

False

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20
Q

What is the regimen for amiodarone as a rate control therapy before and after cardioversion

A

Amiodarone HCl 4 weeks before and continued for 12 months after electrical cardioversion to maintain sinus rhythm

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21
Q

When is rate control not preferred as a first line treatment strategy in atrial fibrillation

A
  1. New-onset atrial fibrillation
  2. Atrial flutter suitable for ablation strategy
  3. Atrial fibrillation with reversible cause
  4. Heart failure caused by atrial fibrillation
  5. Rhythm control more suitable based on clinical judgement
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22
Q

Sotalol is used to control ventricular rate in atrial fibrillation

A

False

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23
Q

Drugs for controlling ventricular rate in atrial fibrillation

A

Beta blockers
Non-DHP- CCB
Digoxin

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24
Q

Factors that’ll affect choice of rate control drug in atrial fibrillation

A

Symptoms
Heart rate
Comorbidities
Patient preference

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25
Q

When is Digoxin monotherapy considered for ijitial rate control

A

Patients with non-paroxysmal atrial fibrillation who are predominantly sedentary or when other rate limiting drugs are unsuitable

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26
Q

Combination therapy for atrial fibrillation and when it is indicated

A

Combination of any 2 of digoxin, beta blocker and Non-DHP CCB

Used when monotherapy is ineffective

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27
Q

What is the next option when combination rate control drugs is not effective in A fib

A

Rhythm control

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28
Q

Preferred rate control combination therapy in heat failure (LVEF < 40%) patientd with A fib

A

Beta blocker and Digoxin

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29
Q

Rhythm control regimen post cardioversion

A

Beta blocker except sotalol as first line

Alternative drugs
Amiodarone
Flecainide
Propafenone
Sotalol

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30
Q

Anti arrhythmic drugs avoided in structural heart disease or ischemic heart disease

A

Flecainide
Propafenone

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31
Q

Amiodarone can be used in heart failure or left ventricular impairment T/F

A

True

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32
Q

Dronedarone is considered as a second line rhythm control drug in……

A

Persistent or paroxysmal atrial fibrillation

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33
Q

Pill-in-the-pocket approach can be used in patients with…….

A

Infrequent episodes of symptomatic paroxysmal atrial fibrillation

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34
Q

What is the pill-in-the-pocket approach

A

Patient takes an oral antiarrhythmic drug to self-treat an episode of atrial fibrillation

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35
Q

Factors the determine when to stop anticoagulation in atrial fibrillation

A

Patient preference
Stroke and bleeding risk
Arrhythmia

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36
Q

Score for assessing stroke risk in A fib

A

CHA2DS2VASc score

37
Q

Score for assessing bleeding risk in atrial fibrillation before anticoagulation

A

ORBIT risk tool

38
Q

CHA2- DS2- VASc risk tool parameters

A

C - Congestive heart failure - 1
H - Hypertension - 1
A- Age of 75 or more - 1

D- Diabetes - 1
S- Stroke/TIA/Thromboembolism - 2

V- Vascular disease - 1
A- Age - 65- 75 - 1
S - Sex (female)- 1

39
Q

CHA2- DS2- VASc risk tool interpretation

A

Give anticoagulation if score is 2 or more
Consider anticoagulation in men if score is 1

40
Q

When is Parenteral anticoagulation with heparin given in atrial fibrillation

A

New-onset atrial fibrillation who are receiving subtherapeutic or no anticoagulation therapy, until
assessment is made and appropriate anticoagulation is
started

41
Q

When is oral anticoagulation given in confirmed atrial fibrillation

A
  1. Stable sinus rhythm has not been successfully restored within 48 hours of onset
  2. Risk of stroke outweighs risk of bleeding
  3. Have had, or are at high risk of, recurrence of atrial fibrillation such as those with structural heart disease, a prolonged history of atrial fibrillation (more than 12 months), or a history of failed attempts at cardioversion
42
Q

When is oral anticoagulation given in confirmed atrial fibrillation

A
  1. Stable sinus rhythm has not been successfully restored within 48 hours of onset
  2. Risk of stroke outweighs risk of bleeding
  3. Have had, or are at high risk of, recurrence of atrial fibrillation such as those with structural heart disease, a prolonged history of atrial fibrillation (more than 12 months), or a history of failed attempts at cardioversion
43
Q

Recommended oral anticoagulation in non-valvular atrial fibrillation

A

Direct acting oral anticoagulants
Apixaban
Edoxaban
Rivaroxaban

Dabigatran

44
Q

If DAOC are contraindicated in a patient with atrial fibrillation, what anticoagulant can be given

45
Q

Aspirin can be used as monotherapy for stroke prevention in patients with atrial fibrillation

46
Q

Role of left atrial appendage ovclusion in atrial fibrillation

A

For stroke prevention if anticoagulant treatment is contra-indicated or not tolerated

47
Q

Role of left atrial appendage ovclusion in atrial fibrillation

A

For stroke prevention if anticoagulant treatment is contra-indicated or not tolerated

48
Q

Treatment approaches for atrial flutter

A

Controlling the ventricular rate
Attempting to restore and maintain sinus rhythm

49
Q

Rate control drugs used in atrial flutter

A

Beta blockers
Non-DHP CCBs
Digoxin

50
Q

Rate control drugs used in atrial flutter

A

Beta blockers
Non-DHP CCBs
Digoxin

51
Q

Preferred drugs for rapid rate control in atrial fibrillation

A

IV Beta blockers
IV Verapamil

52
Q

Conversion to sinus rhythm in atrial flutter can be achieved with

A

Electrical cardioversion
Pharmacological Cardioversion
Catheter ablation

53
Q

How long should anticoagulation be done for in patients with atrial flutter for more than 48 hours or unknow duration before cardioversion and if patient cannot wait what should be done

A

3 weeks

If not possible, parenteral anticoagulation should be given and a left atrial thrombus ruled out before cardioversion

54
Q

How long should anticoagulation be done for in patients with atrial flutter for more than 48 hours or unknow duration before cardioversion and if patient cannot wait what should be done

A

3 weeks

If not possible, parenteral anticoagulation should be given and a left atrial thrombus ruled out before cardioversion

55
Q

How long should oral anticoagulation be done after cardioversion in atrial flutter

A

For at least 4 weeks

56
Q

How long should oral anticoagulation be done after cardioversion in atrial flutter

A

For at least 4 weeks

57
Q

Preferred method of cardioversion in atrial flutter when rapid cardioversion is necessary

A

Direct current cardioversion

58
Q

Preferred method of cardioversion in recurrent atrial flutter

A

Catheter ablation

59
Q

Rhythm control drugs in atrial flutter

A

Flecainide
Propafenone
Amiodarone when other drugs are contraindicated or ineffective

60
Q

Is thromboprohylaxis necessary in atrial flutter

61
Q

Is thromboprohylaxis necessary in atrial flutter

62
Q

Criteria for anticoagulation in atrial flutter is same as in atrial fibrillation. T/F

63
Q

Why do antiarrhythmics have a limited role in atrial flutter

A

Not always effective

64
Q

Initial management of paroxysmal supraventrivular tavhycardia

A

Spontaneous termination
Reflex vagal stimulation

65
Q

Initial management of paroxysmal supraventrivular tavhycardia

A

Spontaneous termination
Reflex vagal stimulation

66
Q

Reflex vagal stimulation techniques

A

Valsava maneuver
Immersing the face in ice cold water
Carotid sinus massage

67
Q

Reflex vagal stimulation techniques

A

Valsava maneuver
Immersing the face in ice cold water
Carotid sinus massage

68
Q

Drugs for PSVT when reflex vagal stimulation fails or severe symptoms are present

A

IV adenosine

69
Q

Drugs for PSVT when reflex vagal stimulation fails or severe symptoms are present

A

IV adenosine

70
Q

Drug to be given in PSVT when IV adenosine is contraindicated or ineffective

A

IV Verapamil

71
Q

Direct cardioversion in PSVT is needed when…..

A

Patient is Hemodynamically unstable
Reflex vagal stimulation fails
Drugs such as IV adenosine and verapamil are ineffective in restoring sinus rhythm

72
Q

Direct cardioversion in PSVT is needed when…..

A

Patient is Hemodynamically unstable
Reflex vagal stimulation fails
Drugs such as IV adenosine and verapamil are ineffective in restoring sinus rhythm

73
Q

Treatment for recurrent episodes of PSVT

A

Catheter ablation
Prevention with drugs

74
Q

Drugs for prevention of PSVT

A

Diltiazem
Verapamil
Beta blockers including sotalol
Flecainide
Propafenone

75
Q

Drugs for bradycardia after myocardial infarction

A

Iv atropine

76
Q

Drug for bradycardia after MI if atropine is ineffective or patient is at risk of asystole

A

Epinephrine by IV infusion

77
Q

Treatment for pulseless ventricular tachycardia or ventricular tachycardia

A

Resuscitation

78
Q

Patients with unstable sustained ventricular tachycardia,who continue to deteriorate with signs of hypotension or reduced cardiac output, should receive …………. to restore sinus rhythm

A

direct current
cardioversion

79
Q

What should be done if direct current cardioversion fails in unstable sustained ventricular tachycardia

A

Give IV Amiodsrone and repeat direct current cardioversion

80
Q

What should be done if direct current cardioversion fails in unstable sustained ventricular tachycardia

A

Give IV Amiodsrone and repeat direct current cardioversion

81
Q

Treatment for hemodynamically stable ventricular tachycardia

A

Intravenousa antiarrhythmics
Amiodarone hydrochloride - preferred
Flecainide acetate
Propafenone hydrochloride
lidocaine hydrochloride - less effective

82
Q

Treatment for hemodynamically stable sustained ventricular tachycardia if IV antiarrhythmics are ineffective

A

Direct current cardioversion
Pacing

83
Q

Treatment for hemodynamically stable sustained ventricular tachycardia if IV antiarrhythmics are ineffective

A

Direct current cardioversion
Pacing
Catheter ablation if urgent cessation of arrhythmia is not needed

84
Q

Maintenance treatment for ventricular tachycardia

A

Implantable cardioverter defibrillator plus beta blocker or sotalol or amiodarone

Or

Implantable cardioverter defibrillator plus amiodarone plus beta blocker

or

Beta blocker with or without amiodarone if Implantable cardioverter defibrillator is not appropriate

85
Q

Torsades de pointes

A

Form of ventricular tachycardia associated with a long QT syndrome

86
Q

Causes of Torsades de pointes

A

Drugs
Hypokalemia
Severe bradycardia
Genetics

87
Q

Treatment of torsades de pointes

A

IV Magnesium sulphate

Beta blocker(not sotalol)

Atrial or ventricular pacing

88
Q

Why are antiarrhythmics not advisable in Torsades de pointes

A

They prolong QT interval and worsen the condition

BNF INTRODUCTIONS (1 decks)

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