Tisedale Flashcards
Supraventricular arrhythmias
-Sinus bradycardia
-Atrioventricular (AV) block
-Sinus Tachycardia
-Atrial Fibrillation
-Supraventricular tachycardia
What is Sinus bradycardia and what can cause it and symptoms
HR that is less than 60 beats per minute, SA node is slower than usual
Causes
MI, too much K or Mg, Drugs: digoxin, diltiazem, beta blockers
Symptoms
Hypotension, dizziness, syncope
Treatment for Sinus bradycardia
Only needed if patient is symptomatic
Atropine 0.5-1mg IV repeat every 5 minutes for max of 3mg dose
LONG TERM treatment
- some patient require permanent pacemaker
What is atrial fibrillation and what causes it and its symptoms
the electrical activity in the atrial is chaotic and disorganized which causes irregularly irregular rhythm and NO P WAVES
Causes of AFIB
- advancing age
- cigarette smoking
- alcohol
-obesity
-left atrial hypertrophy
-hypertension
Symptoms
- palpitations, dizziness, fatigue, lightheadedness, shortness of breath, hypotension, stroke
Atrial Fibrillation stages
STAGE 1
- person who has risk factors for afib but does not have any symptoms
STAGE 2
- do not actual have afib but are noted to be at risk due to findings on a ECG
STAGE 3
- patient has afib and is symptomatic
- 3a - paroxysmal AF
- 3b - persistent AF
- 3c- Long standing persistent AF
- 3d - Successful AF ablation
STAGE 4
- permanent trial fibrillation
Prevention/Treatment of AFIB
210 minutes of vigorous exercise each week
stop smoking
limit alcohol consumption
Anticoagulants
If a woman has 2 or more CHADS-VASC
If a man has 1 or more CHADS-VASC
DOACS are preffered over warfarin
Dabigatran, rivaroxaban, apixaban, edoxaban
Warfarin is for mechanical heart valve patients (INR 2.5-3.5)
Drugs that inhibit AV nodal conduction (slow the HR down)
Diltiazem
Verapamil
Digoxin
Treatment for atrial Fibrillation hospitalization (rate controlling drugs)
Hemodynamically unstable
- Electric shock
Hemodynamically stable
With HFpEF
- beta blocker, diltiazem, or verapamil
(if non-responsive try dig)
- Digoxin
(if dig doesnt work go to ami)
- Amiodarone
Hemodynamically stable with HFrEF
- Amiodarone
GOAL OF TX HR less than 100-110bpm and asymptomatic
what is hemodynamically unstable?
SBP is less than 90mmHg
HR greater than 150bpm
lost consciousness
ischemic chest pain
Treatment for atrial fibrillation hospitalization (Long term ventricular rate control)
HFpEF
- BB, diltiazem, verapamil
HFrEF
- beta blocker
If patients cannot tolerate these treatments try DIgoxin
Atrial fibrillation for conversion of hemodynamically stable AF to sinus rhythm
Normal LV function
- IV amiodarone
- IV ibutilide
OR
-Procainamide (do not give this is already took IV of the other two)
HFrEF
- IV amiodarone
AF in patient that is not hospitalized (oral meds) - must have normal LVEF
- Flecainide
-Propafenone
Maintenance of sinus rhythm following conversion to SR or for paroxysmal Atrial Fibrillation
Normal LVEF, no prior MI
- Dofetilide, dronedarone, flecainide, propafenone
Prior MI or LVEF less than or equal to 40%
- Amiodarone, dofetilide
- sotalol
Prior MI or LVEF less than or equal to 40% and NYHA class III or IV or recent decompensated HF
What is supraventricular tachycardia and its symptoms
HR between 110-250bpm
Narrow QRS complexes
Regular rhythm
symptoms
palpitations, dizziness, weakness, lightheadedness, neck-pounding
Paroxysmal supraventricular tachycardia
Subset of SVT
- intermittent episodes of SVT
Termination of hemodynamically stable SVT
- vagal naeuvers and or IV adenosine
- if ineffective or not feasible IV beta blockers or IV diltiazem or IV verapamil
- If ineffective or not feasible synchronized DCC
Ventricular arryhtmias
Premature ventricular complexes
Ventricular tachycardia
Ventricular fibrillation
