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Therapeutics > W24 Arrhythmia > Flashcards

W24 Arrhythmia Flashcards

1
Q

what is the most common form of arrhythmia

A

artial fibrillation

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2
Q

what is disorganisation of atrial depolarisation

A

electrical and mechanical remodelling of the atrial

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3
Q

what is the pathophysiology of arrhythmia

A 
structural and congential heart disease
ischaemic heart disease 
obesity
advancing age
excess stimulant use
uncontrolled hypertension
hyperthyroidism
associated with most chronic diseases
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4
Q

what are the consequences of atrial fibrilation

A

increases risk of stroke by 5 fold

af strokes are usually more debilitating / disabiling than strokes not caused by atrial fibrilation

uncontrolled atrial fibrilation can lead to congestive heart failure

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5
Q

what are the goals of treatment of arrhythmia

A

relieve symptoms

prevent thromboembolic complications

  • proven mortality benefit
  • bleeding risk
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6
Q

what is the progression of atrial fibrilation

A

disordered contraction in atria cause it to quiver

overrides the sinus node stimulus

usually started as paroxysmal events

repeated paroxysms = additional stress on the atria
- progressive fibrosis and scarring from this stress atrial dilation.

over time usually develops into persistent atrial fibrilation

if persists for > 1 year it is considered permanent atrial fibrilation.

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7
Q

what are the symptoms of a stroke

A

facial weakness
arm weakness
speach issues
time

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8
Q

how is atrial fibrilation diagnosed

A

pulse check

ECG to confirm

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9
Q

what are some potential causes of atrial fibrilation

A 
hyperthyroidism
pulmonary embolus
anaesthesia 
electrolyte disturbance
alchohol binge
sepsis
stimulant drug use
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10
Q

what is the referal criteria

A

refer all those with irregular pulse to GP asap

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11
Q

when should a patient be sent to to emergency services

A 
haemodynamic instability
stroke
heart failure
PE
thyrotoxicosis
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12
Q

what are the symptoms of atrial fibrilation

A 
palpitations
breathlessness
syncope
dizziness
chest pain and discomfort
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13
Q

what events may prompt for investigation for atrial fibrilation

A

stroke or TIA

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14
Q

how do we identify risks when dealing with atrial fibrilation

A

CHADSVASC

2 or more - anticoagulation

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15
Q

what are the two main treatment options of atrial fibrilation

A

Rate

Rhythm

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16
Q

when is rhythm control considered

A

patients who remain symptomatic despite adequate rate control therapy

those with infrequent but symptomatic episodes of paroxysmal AF

new onset AF where a reversible cause is likely

those whose heart failure is thought to be caused by AF

those with haemodynamic instability

17
Q

what are the advantages of rate control

A

therapeutically convenient

less exposure to drug toxicity

optimal rate control adequate to decrease hospitalisation

cost effective

18
Q

what are the disadvantages of rate control

A

no effect on disease progression

may not be beneficial in highly symptomatic patients

19
Q

what are the advantages of rhytm control

A

prevents disease progression

avoids unfavourable electrical and structural remodelling

potentially preferable in younger patients

better quality of life

20
Q

what are the disadvantages of rhytm control

A

exposure to adverse effects of antiarrhytmic drugs

generally less cost effective

21
Q

what is the first line of rate control

A

beta blocker (licensed option)

rate limiting calcium channel blocker

22
Q

2nd line of rate control

A

digoxin monotherapy only for sedentary patients

23
Q

what is the choice between first and 2nd line

A

co morbidities and critieria changes for different ages

24
Q

what pharmacological items can be used in rhym control

A

if <48 hours duration anti arrhymtic drugs can be used

25
Q

what are some example antiarrhythmic drugs

A

sotalol
amiodarone
flecainide
propafenone

26
Q

what are non pharmacological approaches to control rhythm

A

Direct current cardioversion DCCV

electrical reset to try and get heart to go back into SR

Increased success rate whe ncombined with antiarrhythmic treatment before and continued for 6 weeks after

if 48 hours duration

27
Q

what are the side effects of treating atrial fibrilation

A

anticoagulation haemorrhage

rate control

  • bradycardia if over treated
  • hypotension for some drugs
  • other drug specific options

rhythm control
- amiodarone loads of side effects

28
Q

what si the difference between anti platelet vs anticoagulant

A

arterial clots = antiplatelet
platelet rich clot treated with aspirin and clopidogrel

venous clots
fibrin rich clot
treated with warfarin

Therapeutics (50 decks)

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