W24 Arrhythmia Flashcards
what is the most common form of arrhythmia
artial fibrillation
what is disorganisation of atrial depolarisation
electrical and mechanical remodelling of the atrial
what is the pathophysiology of arrhythmia
structural and congential heart disease ischaemic heart disease obesity advancing age excess stimulant use uncontrolled hypertension hyperthyroidism associated with most chronic diseases
what are the consequences of atrial fibrilation
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
what are the goals of treatment of arrhythmia
relieve symptoms
prevent thromboembolic complications
- proven mortality benefit
- bleeding risk
what is the progression of atrial fibrilation
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.
what are the symptoms of a stroke
facial weakness
arm weakness
speach issues
time
how is atrial fibrilation diagnosed
pulse check
ECG to confirm
what are some potential causes of atrial fibrilation
hyperthyroidism pulmonary embolus anaesthesia electrolyte disturbance alchohol binge sepsis stimulant drug use
what is the referal criteria
refer all those with irregular pulse to GP asap
when should a patient be sent to to emergency services
haemodynamic instability stroke heart failure PE thyrotoxicosis
what are the symptoms of atrial fibrilation
palpitations breathlessness syncope dizziness chest pain and discomfort
what events may prompt for investigation for atrial fibrilation
stroke or TIA
how do we identify risks when dealing with atrial fibrilation
CHADSVASC
2 or more - anticoagulation
what are the two main treatment options of atrial fibrilation
Rate
Rhythm
when is rhythm control considered
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
what are the advantages of rate control
therapeutically convenient
less exposure to drug toxicity
optimal rate control adequate to decrease hospitalisation
cost effective
what are the disadvantages of rate control
no effect on disease progression
may not be beneficial in highly symptomatic patients
what are the advantages of rhytm control
prevents disease progression
avoids unfavourable electrical and structural remodelling
potentially preferable in younger patients
better quality of life
what are the disadvantages of rhytm control
exposure to adverse effects of antiarrhytmic drugs
generally less cost effective
what is the first line of rate control
beta blocker (licensed option)
rate limiting calcium channel blocker
2nd line of rate control
digoxin monotherapy only for sedentary patients
what is the choice between first and 2nd line
co morbidities and critieria changes for different ages
what pharmacological items can be used in rhym control
if <48 hours duration anti arrhymtic drugs can be used
what are some example antiarrhythmic drugs
sotalol
amiodarone
flecainide
propafenone
what are non pharmacological approaches to control rhythm
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
what are the side effects of treating atrial fibrilation
anticoagulation haemorrhage
rate control
- bradycardia if over treated
- hypotension for some drugs
- other drug specific options
rhythm control
- amiodarone loads of side effects
what si the difference between anti platelet vs anticoagulant
arterial clots = antiplatelet
platelet rich clot treated with aspirin and clopidogrel
venous clots
fibrin rich clot
treated with warfarin
