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Prescribing PSA / Management > Rhythm Disorders > Flashcards

Rhythm Disorders Flashcards

1
Q

When is digoxin given for AF?

A

It’s 2nd line if non-paroxysmal and sedentary

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2
Q

Carbimazole for hyperthyroidism needs to be promptly stopped when?

A

If the pt has signs of infection, take bloods. If low WCC (bc can cause agranulocytosis and neutropenia) need to stop the carbimazole ASAP

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3
Q

Give some common causes of bradycardia

A
  • Physiological (sleep, athletes)
  • Cardiac (AV block, sinus node disease)
  • Non-cardia (vasovagal, hypothermia, hypothyroidism, hyperkalaemia)
  • Drugs (B-blockers, diltiazem, digoxin, amiodarone)
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4
Q

What’s given for chemical cardioversion? When is it given for AF?

A

Given only after 3w of anticoagulation (if not acutely unwell)

  • Anti-arrhythmic e.g. flecainide, amiodarone (If structural / IHD -> amiodarone) (300mg IV over 20-60 mins followed by 900mg infusion over 24hrs)
  • Give a rate-control drug at the same time (Beta-blocker e.g. bisoprolol, metoprolol, esmolol, carvedilol (not sotalol), or rate limiting CCB e.g. diltiazem or verapamil (NOT CCB if HF w/ reduced EF)
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5
Q

If you’ve given someone cardioversion, what anticoagulation do you give them?

A
  • Start anticoagulation w/ heparin or enoxaparin pre-cardioversion
  • Then continue a DOAC for >4w if have been in AF for >24hrs e.g. rivaroxaban, apixaban, edoxaban, dabigatran, warfarin
  • After 4w, decide about continuation using CHA2DS2VASc
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6
Q

What is involved in the CHADVASC score?

A

CHA₂DS₂-VASc

  • CHF
  • BP >140/90 or current antihypertensives
  • Age > 75yo (2 points)
  • DM
  • Stroke, TIA (2 points)
  • Vascular disease (MI, PAD, aortic plaque)
  • Age 65-74
  • Sex (female)
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7
Q

How do you manage bradycardias which are “unstable” (shock, syncope, myocardial ischaemia, HF)?

A
  • Treat the cause
  • 500mcg IV atropine every 3-5 mins up to 3mg (i.e. 6 times) (unless cardiac transplant, and beware in MI)
  • Then can consider 2nd line drugs or proceed to transcutaneous pacing
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8
Q

Which peri-arrest rhythms are adenosine given for? What dose

A

Regular narrow-complex tachycardias (sinus tachycardia, paroxysmal SVT (AVNRT, AVRT (WPW)), atrial flutter w/ regular AV conduction

Vagal manoeuvres -> 6mg adenosine as rapid IV bolus -> 12mg adenosine -> 12mg adenosine

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9
Q

What CHA2DS2VASc score indicates the need for anticoagulation?

A

> 2 in females or >1 in men

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10
Q

Give an example of an anticoagulant and dose used for AF

A

DOAC e.g. 20mg rivaroxaban od

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11
Q

Which peri-arrest rhythms do you shock?

A

Tachycardias which are “unstable” i.e. shock, syncope, myocardial ischaemia, HF

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12
Q

What rate control is given for AF if they fail to respond to one drug?

A

Can combine 2 of BB, diltiazem and digoxin if no improvement

Beta-blocker e.g. bisoprolol, metoprolol, esmolol, carvedilol (not sotalol)

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13
Q

When given DC electrical cardioversion, what drugs need to be given at the same time?

A
  • Anaesthetic drugs

- Start anticoagulation pre-cardioversion (heparin/enoxaparin) or continue their current anticoagulation

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14
Q

What scoring systems are used to decide on giving anticoagulation in AF?

A

o CHA2DS2VASc

o HAS-BLED

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15
Q

What rate control is given for AF?

A

AV nodal blocking drugs:
• Beta-blocker e.g. bisoprolol, metoprolol, esmolol, carvedilol (not sotalol)
• Rate limiting CCB e.g. diltiazem or verapamil (NOT if HF w/ reduced EF)

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16
Q

Which peri-arrest rhythms respond to vagal manoeuvres?

A

Regular narrow-complex tachycardias (sinus tachycardia, paroxysmal SVT (AVNRT, AVRT (WPW)), atrial flutter w/ regular AV conduction

17
Q

What is involved in the HAS-BLED score?

A
  • HTN >160
  • Harmful alcohol
  • Abnormal liver function
  • Abnormal renal function
  • Stroke
  • Bleeding Hx or predisposition
  • Labile INR
  • Elderly >65yo
  • Drugs (antiplatelets, NSAIDs)
18
Q

When may atropine be CI for bradycardias? What can you give instead?

A

 BEWARE in acute myocardial ischaemia / MI bc may cause worsening ischaemia
 AVOID if cardiac transplant

 Consider 100-200mg theophylline by slow IV injection if acute inferior MI, spinal cord injury or cardiac transplant
 Consider proceeding straight to transcutaneous pacing

19
Q

When starting warfarin, what else do you start and why?

A

Start unfractionated heparin / LMWH at same time, until INR 2.0-3.0

20
Q

How are peri-arrest tachycardias classified? Give examples of each

A

Narrow-complex (<0.12s / 3 small squares):

  • Regular: sinus tachy, paroxysmal SVT (AVNRT, AVRT (WPW)), atrial flutter w/ regular AV conduction
  • Irregular: AF, or atrial flutter w/ variable AV conduction

Broad-complex:

  • Regular: VT (or SVT w/ BBB)
  • Irregular: AF w/ BBB, AF w/ WPW, polymorphic VT (torsade de pointes)
21
Q

What can be given for bradycardia?

A

IV atropine or isoprenaline

500mcg IV atropine - repeat every 3-5 mins up to 3mg (i.e. 6 times)

22
Q

What can be given for bradycardias caused by acute inferior MI, spinal cord injury or cardiac transplant?

A

100-200mg theophylline

23
Q

What anticoagulation is given for AF longterm?

A

DOAC: apixaban, dabigatran, rivaroxaban, or vit K antagonist

24
Q

What J of cardioversion do you use when?

A

o Cardiovert w/ 120-150J if broad-complex tachycardia or AF

o Cardiovert w/ 70-120J if narrow-complex tachycardia or atrial flutter

25
Q

How is VT treated?

A

300mg IV amiodarone over 20-60 mins, followed by 900mg infusion over 24hrs

26
Q

What doses of amiodarone are given for peri-arrest rhythms?

A

Loading dose of 300mg IV over 20mins, followed by a 900mg infusion over 24hrs if:

  • Unstable tachycardia (shock, syncope, myocardial ischaemia, HF)
  • AF
  • VT
27
Q

How do you treat an unstable (shock/syncope/MI/HF) tachycardia?

A

DC cardioversion (up to 3 times) -> still unstable? -> amiodarone and re-attempt cardioversion

o Can also do vagal manoeuvres if regular narrow complex tachycardia
o Cardiovert w/ 120-150J if broad-complex tachycardia or AF
o Cardiovert w/ 70-120J if narrow-complex tachycardia or atrial flutter
o Give amiodarone as a loading dose of 300mg IV over 10-20mins, followed by a 900mg infusion over 24hrs

28
Q

How are regular narrow-complex tachycardias managed?

A

Vagal manoeuvres -> 6mg adenosine as rapid IV bolus -> 12mg adenosine -> 12mg adenosine
o Carotid sinus massage, Valsalva manoeuvre
o Adenosine quickly through large cannula, may cause chest discomfort
o These steps should almost always terminate AVNRT/AVRT (check for signs of atrial flutter)

29
Q

Give an examples of a rate-control drug and dose used in AF

A

Beta-blocker e.g. bisoprolol 1.25mg od

Prescribing PSA / Management (8 decks)

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