Therapeutics of arrhythmias

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Author:
alvo2234
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212406
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Therapeutics of arrhythmias
Updated:
2013-04-11 12:02:47
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Candace Jeffereson
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PT II
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  1. P wave shows
    the contraction of the atria
  2. QRS complex measures
    the contraction of the ventricles
  3. t wave shows
    the repolarization of the ventricles
  4. electric shock is administered at what segment
    QRS segment
  5. types of supraventricular arrhythmias
    • atrial fibrillation/atrial flutter
    • sinus tachycardia
    • supraventricular tachycardia
  6. types of ventricular arrhythmias
    • ventricular fibrillation
    • ventricular tachycardia
    • PVCs
  7. types of bradyarrhythmias
    • sinus bradycardia
    • heart blocks
    • asystole
    • PEA
  8. AF EKG reading
    • no discernible p wave
    • irregularly irregular
    • R-R interval irregular (no constant distance)
    • rapid ventricular rate
  9. Cardiogenic etiology of AF
    • HF
    • HTN
    • IHD
    • valvular heart disease
  10. non-cardiogenic etiology of AF
    • PE
    • hyperthyroidism/hypothyroidism
    • acute infection
    • excessive alcohol intake
    • post surgery (CABG)
  11. new onset AF
    within 48 hrs
  12. acute AF
    within 1 yr
  13. paroxysmal AF
    intermittent A. Fib
  14. Chronic AF
    more than 1 yr
  15. clinical manifestations of AF
    • palpitations
    • dizziness
    • chest pain
    • dyspnea
    • syncope
    • irregular/ rapid pulse
    • limited exercise tolerance
    • asymptomatic
  16. Treatment goals of AF
    • rate control
    • rhythm control
    • stroke prohphylaxis
  17. agents used to control the rate of control in AF
    • digoxin
    • beta blockers
    • CCB
  18. agents used to control the rhythm of AF
    • antiarrythmics
    • DCC (for hemodynamically compromised)
  19. how long must pts have AF for stroke prophylaxis
    > 48 hours
  20. when is digoxin preferred and not preferred in AF pts
    preferred in HF pts but not in symptomatic pts bc of prolonged action
  21. New onste/acute AF asymptomatic treatment with EF > 40%
    • CCB (non dhp)
    • b-blocker
    • digoxin
  22. new onset acute symptomatic AF with EF > 40
    • non dhp CCB
    • b-blockers
  23. new onset/acute asymptomatic AF with EF < 40
    • digoxin
    • CCB
    • amiodarone
    • b-blocker
  24. new onset/ acute symptomatic AF with EF < 40
    • CCB
    • amiodarone
    • digoxin
  25. chronic/paroxysmal AF with EF > 40
    • CCB
    • b-blocker
    • digoxin
  26. chronic/PAF with EF < 40%
    • digoxin
    • b-blocker
  27. AFFIRM/RACE trial
    no difference between rhythm and rate control
  28. dofetilide parameters
    • pts has to be hospitalized for 3 days
    • increase in QT interval
    • must be monitored before sent home
  29. antiarrhythmic medications (rhythm control) proven to be safe in HF pts
    • amiodarone
    • dolfetinide
  30. antiarrhythmic agents proven to be useful in CAD
    • sotalol
    • dofetilide
    • amiodarone
  31. drug used to treat AF pt with no HF and has HTN with LVH > 1.4 cm
    amiodarone
  32. black box warning for Dronedarone
    Class IV HF or class II to III HF with recent decompensation requiring hospitalization
  33. atrial flutter EKG
    • p waves in rapid succession
    • sawtooth pattern
    • regular irregular rhythm
  34. Etiologies of atrial flutter
    • pericarditis
    • cardiomyopathy
    • electrolyte abnormalities
    • infection
  35. clinical manifestations of atrial flutter
    • palpitations
    • syncope
    • limited exercise tolerance
    • asymptomatic
  36. supraventricular tachycardia EKG reading
    • no p waves
    • narrow QRS complex
    • regular rhythm
  37. SVT manifestations
    • HR 160-180
    • palpitations
    • hypotension
    • dizziness
    • syncope
    • SOB
  38. clinical manifestations of PVCs
    • usually asymptomatic
    • palpitations
    • dizziness
  39. Cast Trial
    IC antiarrhythmics cannot be used for asymptomatic PVCs
  40. what drug should be used in PVC pts with MI
    B-blocker
  41. what drug should be used in high risk PVC pts with MI
    amiodarone
  42. Sinus Bradycardia EKG reading
    • regular rhythm
    • rate < 60
    • normal p waves and QRS complexes
  43. first degree AV block EKG reading
    • long PR interval (> 0.2 sec)
    • regular rhythm
    • normal p wave
  44. second degree AV block (type 1)
    • PR interval prolongation
    • QRS dropped in a repeating pattern
    • block is at the AV node
  45. second degree AV block type II EKG reading
    • -dropped QRS complexes
    • -prolonged PR interval with each beat until a P wave appears without QRS complex
    • -irregular ventricular rhythm
    • -block is below the AV node within the His- psystem
  46. Third-Degree AV Block EKG reading
    no electrical association between atria and ventricle

    no relationship between p waves and QRS complexes
  47. AV block arrhythmias etiology
    • damage to the SA node
    • increased parasympathetic tone
    • hypoxemia
    • medications
  48. clinical manifestations of AV block arrhythmias
    • slow, regular pulse
    • hypotension
    • syncope
    • confusion
    • blurred vision
    • asymptomatic
  49. when do you treat AV block arrhythmias
    only if pt is symptomatic
  50. medications used to treat AV block arrhythmias
    • Atropine
    • consider epinephrine
  51. Asystole EKG reading
    • no p wave, QRS complex
    • no rate
    • no rhythm
  52. Etiology of Asystole
    • hypovalemia
    • hypoxia
    • hydrogen ions (acidosis)
    • hypo/hyperkalemia
    • hypothermia
    • toxins
    • tamponade
    • tension pneumothorax
    • thrombosis
    • trauma
  53. Asystole clinical manifestations
    • unresponsive
    • no pulse
    • no respiration
    • no electrical activity
  54. Pulseless Electrical Activity (PEA) EKG reading
    • slow, normal, fast rate
    • regular or irregular rhythm
    • P wave may or may not be present
    • PR interval may be normal or prolonged
  55. what is the treatment for PEA/ Asystole/ Asystole
    • CPR
    • 5H's and 5T's
    • Medications (epinephrine, vasopressin)
  56. what is NOT to be used to treat PEA/Asystole
    defibrillation
  57. treatment for SVT
    • DCC
    • vagal maneuvers
    • adenosine
    • b-blockers
    • non dhp CCBs
  58. drugs used to treat  hemodynamically stable SVT pt with EF > 40
    • adenosine
    • non DHP CCB
    • b-blockers
    • digoxin
  59. drugs used to treat hemodynamically stable SVT pts with EF < 40
    • adenosine
    • digoxin
    • amiodarone
    • non DHP CCB
  60. when is DCC not used in SVT pts
    when they are hemodynamically stable and have an EF < 40
  61. clinical manifestations of VT
    • hypotension
    • no pulse
    • syncope
    • unresponsiveness
  62. non sustained pulse
    last < or equal to 30 sec
  63. sustained pulse
    > 30 sec
  64. drugs to treat a non sustained VT pt with EF > 40
    beta blocker
  65. how to treat non sustained VT with EF < 40 and EP demonstrates inducible VT/VF
    AICD
  66. drugs to treat non sustained VT with EF < 40 and EP does NOT demonstrate inducible VT/VF
    • b-blockers
    • amiodarone
  67. how to treat hemodynamically stable sustained VT with EF > 40
    • procainamide
    • amiodarone
    • lidocaine
  68. how to treat hemodynamically stable sustained VT pts with EF < 40
    • amiodarone
    • lidocaine
  69. clinical manifestations of VF
    • hypotension
    • syncope
    • palpitations
    • SOB
    • angina
  70. treatment for VF/pulseless VT
    • CPR
    • defibrillation
    • epinephrine/vasopressin
    • amiodarone/lidocaine

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