tachyarrhythmias, afib and aflutter Flashcards
common causes of sinus tachycardia
- exercise
- anxiety
- pain
- stimulants
- volume depletion
- anemia
- hypoxia
- PE
- pericarditis
treatment for tachycardia
- treat underlying cause
AVNRT
- AV nodal reentry tachycardia
- electrical conduction gets trapped in a loop around AV node
AVRT
- av reciprocating tachycardia
- wider circuit
- accessory pathway through AV node into atria and ventricles
junctional tachycardia
- originates in AV node
main symptom of SVT
- sudden onset and offset
management of stable SVT
- first line= vagal maneuvers* or carotid massage
- adenosine 6 mg IVP, 12 mg IVP, 12 mg IVP
- BB or CCB
- frequent attacks require ablation
management of unstable SVT
- vagal maneuvers first line
- DC cardioversion if unsuccessful
sx of vtach
- heart palpitations
- near syncope or syncope
- chest pain, SOB, diaphoresis
- sustained LOC
- death
treatment for vtach with pulse
- stable- amiodarone IV bolus then cont infusion, ICD
- unstable- DC cardioversion
treatment vtach without pulse
- CPR
- defibrillation
- epi
torsades de pointes triggers
- hypoK
- hypoMg
- drugs that prolong QTc:
- antiarrhythmic drugs
- antipsychotics
- abx
- antidepressants
antiarrhythmics that prolong QTc
- amiodarone
- flecainide
- sotalol
antipsychotics that prolong QTc
- chlorpromazine
- haloperidol
- olanzapine
- quetiapine
- risperidone
abx that prolong QTc
- azithromycin
- levofloxacin
- ciprofloxacin
antidepressants that prolong QTc
- citalopram
- TCAs
treatment for torsades
- IV mg firstline
- temp transvenous overdrive pacing if no response to Mg
- if unstable requires defibrillation
causes of vfib
- MI most common
- HF
- hypoxemia or hypercapnia
- hypotension/ shock
- electrolyte abnormalities
- stimulates
- often preceded by vtach
assoc conditions with vfib
- LVH
- HOCM
- CHF
- aortic stenosis
- brugada syndrome
treatment for vfib
- CPR
- defibrillation
- if pulse regained consider cardiac cath and ICD
afib
- rapid irregular atrial contraction
- no p waves
- usually assoc with HR of 120-160
- high stroke risk
- more common in elderly, males, and whites
etiology of afib
- hyperthyroidism*
- acute vagotonic episode
- alcohol
- post op
- atrial enlargement
- disruption of electrical conduction sys
where does ablation occur for afib
- ostial portion of pulmonary veins
risk factors for afib
- age > 64
- male
- HTN
- obese
- prolonged PR interval
- valve disease*
- CHF
paroxysmal afib
- intermittent
persistent afib
- fails to terminate within 7 days
- requires intervention
permanent afib
- lasts > 12 mo
- no longer pursue rhythm control
sx of afib
- may be asymptomatic
- heart palpitations
- presyncope or syncope
- SOB and exs intolerance
- chest pain
- fatigue
triggers of afib
- sleep deprivation
- physical illness
- post op
- stress
- hyperthryoidism
- physical exertion
- stimulant meds
- alcohol, caffeine
- dehydration
what should every person with afib have during work up>
- TTE to assess for valve disease
- TSH levels
what is the best method for detecting atrial thrombus
- TEE
- very invasive
goals of afib tx
- rhythm control- always tried first
- rate control to prevent tachy CMP or ischemia
- decrease stroke risk with anticoags
- alleviate sx
who requires urgent DC cardioversion for afib
- unstable hemodynamics
- evidence of hypoperfusion
- severe manifestations of HF
- WPW
non-urgent DC cardioversion
- new onset/ dx afib
- persistent afib who are limited by sx
- before cardiversion control ventricular rate and provide IV heparin
tx prior to DC cardioversion for afib
- anticoag tx X 3 weeks OR TEE to determine if thrombus present
c/i to cardioversion for afib
- known afib with minimal sx
- multiple comorbidities
- unlikely to maintain NSR
- benefits decrease after 80
- paroxysmal afib
- known clot or sx > 48 hours without anticoag tx X 3 weeks
complications of afib
- ischemia
- pulmonary edema
- tachycardia induced CMP
- stroke
treatment for rate control in afib
- BB or CCB first line (IV then PO)
- digoxin added to BB or CCB
- amiodarone last line
side effects of amiodarone
- abnormal LFTs
- pulmonary toxicity- chronic interstitial pneumonitis
how do you determine stroke risk for afib pts
- CHADS2 score
- CHADS2-VASc score which is more specific if pt falls into intermed risk
anticoag tx options for afib
- warfarin
- dabigatran
- rivaroxaban
- apixaban
warfarin
- competitively depletes vit K
- 5-7 days for full therapeutic effect
- goal INR of 2-3
- CYP2C9 interactions
- no bridging for afib
indications for hospitalizations with afib
- ablation of accessory- WPW
- treat assoc medical problems that are trigger
- manage rate or sick sinus syndrome
treatment of aflutter
- rate control more difficult than afib
- usually respond well to ablation
- anticoag tx prior to abalation X 1 month or if recurrent
where does ablation occur for aflutter
- large macroreentrant pathway of RA
