Rhythm Disorders (Afib, A-flutter) Flashcards
Atrial Fib workup
- Echo (look for clotch, valve problems, left atrial size)
- Thyroid Function
- Electrolytes (K, Mg, Ca)
- Troponin or Ck-MB (some cases of acute onset)
Atrial Fib tx
Unstable (systolic BP <90, CHF, confusion, chest pain): synchronized electrical cardioversion (evn /o TEE or anticoagulation).
Stable: rate control meds (beta blockers: carvedilol, metoprolol; CCBs: diltiazem; digoxin).
When to give anticogulation in a fib?
when the patient is stable and if the a fib have persisted for more than two days.
What type of oral anticoagulants are used in a fib?
NOACs (dabigatran[thrombin in.], rivaroxaban, edoxaban, and apixban).
How to reverse warfarin in severe bleeding?
Fresh frozen plasma or pro-thrombin complex concentrate (PCC).
How to reverse dabigatran in severe bleeding?
Idarucizumab
How to reverse rivaroxaban/edoxaban in severe bleeding?
Andexanet
When to use warfarin instead of NOACs in a fib?
When the patient have metallic heart valves.
Scoring system for anticoagulation
CH2-DS2-VASC
CHF
Hypertension
Age >75 (gets 2 points)
Diabetes
Stroke/TIA (gets 2 points)
Vascular disease
Age 65-74
Sex (male)
Scoring system for anticoagulation interpretation treatment?
0-1
>=2
>2
0-1: aspirin or nothing
2>=: use Xa inhibitos (rivaroxaban/epixaban/apixaban), dabigratan + control rate.
When to use beta blockers?
Ischemic Heart Disease
Migraine
Graves disease
Pheochromocytoma
When to use CCBs?
Asthma
Migraine
When to use Digoxin?
Borderlline hypertension
What is the treatment for multifocal atrial tachycardia (MAT)?
Oxygen first (specially if pO2 <55% Then, Diltiazem
DO NOT USE BETA BLOCKERS!
What is the management for supraventricular tachycardia (SVT)?
- Synchronized cardioversion if unstable.
or - Vagal manuever for stable patients (carotid sinus massage, ice immersion of the face, valsalva).
- If manuevers don’t work give IV adenosine.
- If IV adenosine doesn’t work use beta blockers, diltiazem, or digoxin.
