L 59 Therapeutics of Dysarythmia

Question 1

Risk factors for arrhythmia x7

Answer 1

• Heart damage
• Valve disorders
• Electrolyte imbalance
• Congenital heart conditions
• Drug induced
• Age
• Sleep Apnea (stop beating while sleeping)

Question 2

Types of arrhythmia

Answer 2

Tachycardia
Bradycardia
Irregular heart heart

(supraventricular arrhythmias, ventricular arrhythmias, inherited arrhythmias)

Question 3

The most common irregular heart beat:

Answer 3

Atrial fibrillation

Question 4

What is the increase in fold of stroke risk with atrial fibrillation?

Answer 4

4-5 fold increase

Question 5

What % of people over 65 in NZ have AF?

Answer 5

5%

Question 6

Clinical presentation of dysrhythmias x4

Answer 6

• May be asymptomatic
• Palpitations
• Dizzy
• Potential: anxiety, shortness of breath, loss of consciousness, cardiac arrest

Question 7

How you will Diagnostics of dysrhythmias x5

Answer 7

Clinical signs and symptoms
Vital signs
ECG
Holter monitor
ECHO

Question 8

Goals of therapy

Answer 8

• Prevent mortality and complications
• Alleviate symptoms
• Normalise signs
• Control heart rate

Question 9

… is the most common

Answer 9

arrhythmia

Atrial fibrillation

Question 10

Incidence of AF increases with …

Answer 10

Incidence increases with age

Question 11

AF is when … conduct … across the atria, leading to fibrillation.
Atrial rate:

Answer 11

AF is when impulses conduct irregularly across the atria, leading to fibrillation.
Atrial rate: 350-600bpm

Question 12

What we should be Concern of atrial fibrillation?

Answer 12

Atrial Thrombus formation due to stasis

Question 13

Specialist investigations and non-drug interventions

Answer 13

ECG
Echocardiogram
Acute electrical cardioversion

Question 14

What is an echocardiogram used for?

Answer 14

To rule out structural abnormalities, and it might influence management strategies

Question 15

If presenting within 48 hours of symptom onset, an … may be considered (specialist investigation)

Answer 15

Acute electrical cardioversion

Question 16

Monitoring efficacy for the following is done how often and by who?
Vitals (HR/BP)
Physical exam (palpitations, syncope)
Diagnostics (ECG)
Other (exercise capacity)

Answer 16

Vitals (HR/BP): weekly by patient/pharmacist
Physical exam (palpitations, syncope): each visit by patient + pharm combo
Diagnostics (ECG): 3-6monthly by physician
Other (exercise capacity): each visit, pharmacist to ask

Question 17

Management strategy of choice in an atrial fibrillation patient is…
What risk: benefits need to be weighed?

Answer 17

ANTICOAGULATION

Weigh: benefits and risks of stroke prevention with bleeding risk.

Question 18

How does Afib cause stroke?

Answer 18

Turbulent flow by change in rhythm/rate –> blood stasis and structural abnormalities increase chance of clot formation –> travels to brain –> stroke

Question 19

Name the 2 scoring tools for efficacy and safety of AF?

Answer 19

CHA2DS2-VASc (chadvasc)

HASBLED

Question 20

What is a key risk factor for both ischaemic stroke and bleeding?

Answer 20

Age

Question 21

Overview of CHADVASc scoring tool x2

Answer 21

• Anticoagulants are indicated is score is >2 for females, and >1 for males

Assesss ischaemic stroke risk using clinical and demographic information

Question 22

HASBLED scoring tool overview x2

Answer 22

Assesses bleeding risk

No specific cut off for anti-coagulant risk