thera arrhythmias

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coal
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thera arrhythmias
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2013-12-10 11:31:22
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thera arrhythmias
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thera arrhythmias
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  1. 4 features of an EKG
    • p=atrial contraction
    • QRS=ventricular contracton & atrial repolarization
    • T=ventricular repolarization
    • QT=ventricular depolarization & repolarization
  2. cause of abnormality in impulse generation and examples
    • automatic tachycardias
    • sinus & junctional
  3. causes of abnormality in impulse conduction and examples
    • reentrant tachycardias
    • AF
    • atrial flutter
    • recurrent VT
  4. 1A antiarrhythmics
    • quinidine
    • procainamide
    • disopyramide
  5. 1B antiarrhythmics
    • lidocaine
    • mexilitine
  6. 1C antiarrhythmics
    • flecainide
    • propafenone
  7. class II antiarrhythmics
    • beta blockers
    •   metoprolol
    •   esmolol
    •   atenolol
  8. class III antiarrhythmics
    • amiodarone
    • dofetilide
    • dronedarone
    • sotalol
    • ibutilide
  9. class IV antiarrhythmics
    • verapamil
    • diltiazem
  10. 4 supraventricular arrhythmias
    • atrial fibrillation
    • atrial flutter
    • paroxysmal supraventricular tachycardia
    • automatic atrial tahycardias
  11. most devastating complication of AFib
    embolic stroke
  12. difference in symptoms between the arrhythmias
    AFib & Aflutter don't have syncope
  13. class I ion blocked
    Na
  14. class III ion blocked
    K
  15. class IV ion blocked
    Ca
  16. class II ion blocked
    beta
  17. 6 clinical presentations of supraventricular arrhythmias
    • dizziness
    • acute syncope
    • symptoms of HF
    • angina chest pain
    • choking or pressure during tachy episode
  18. describe the rhythm of a fib
    irregularly irregular with no P waves
  19. describe the rhythm of A flutter
    • regularly irregular
    • sawtooth
    • 3:1 AV conduction
  20. predominant mechanism of A fib & flutter
    • reentry
    • AFib - multible
    • Aflutter - single dominant
  21. Tx of new-onset, symptomatic AFib or flutter if hemodynamically unstable
    • direct current cardioversion DCC
    • restore rhythm and rate
  22. Tx of Afib or flutter when hemodynamically stable = normal LV function LVEF > 40%
    • restore rate
    • 1st - IV beta blockers
    • 2nd - calcium channel blockers
  23. Tx of Afib or flutter when hemodynamically stable and LVEF < 40%
    • IV beta blockers - use with caution
    • avoid - calcium channel blockers
  24. what is the go to if you have Afib or flutter and  CI to beta blockers, CCB's & digoxin and there is a low EF
    amiodarone
  25. Tx of Afib or flutter when hemodynamically stable LVEF < 40% and heart failure exacerbation
    • digoxin
    • amiodarone
  26. what 3 cases should you consider electrical or cardioconversion (for rhythm) in pts with Afib
    • remain symptomatic despite having adequate ventricular rate control
    • adequate ventricular rate control cannot be achieved
    • experiencing their 1t episode of AF if they are likely to convert and remain in SR
  27. if treated Afib or flutter with little response and you are going to cardioconvert when do you use anticoags and how often
    • AF > 48 hours = warfarin 3 weeks prior, goal INR 2.5, and 4 weeks post conversion & return of normal sinus rhythm
    • AF < 48 hours = no anticoag, just convert, maybe LMWH at presentation prior to converting
  28. you are going to pharmacologic cardioconvert and it has been w/I 7 days, what would you use
    • IC - flecainide 600mg, propafenone 300mg
    • III - ibutilide, dofetilide & amiodarone PO or IV
  29. you are going to pharmacologic cardioconvert and it has been > 7 days, what would you use
    III - ibutilide, dofetilide & amiodarone
  30. when pharmacologic cardioconversion is being considered what risk factors should be considered
    • structural heart disease
    •   LV dysfunction
    •   CAD
    •   valvular disease
    •   LV hypertrophy
  31. pharmacologic cardioconversion w underlying SHD
    • amiodarone
    • dofetilide - therapy initiated in hospital (QT)
  32. pharmacologic cardioconversion w/o underlying SHD
    • flecainide
    • propafenone
    • ibutilide - restricted to hospital use
  33. CHADS2 score
    • Congestive hear failure - 1
    • HTN or being treated for - 1
    • Age > 75 - 1
    • Diabetes - 1
    • S previous stroke or TIA - 2
  34. CHADS2 score of 1
    • intermediated risk for stroke
    • oral anticoagulation
    •   pradaxa - 150 mg BID
    •   warfarin - INR 2-3
    •   aspirin - 75-325mg/day + clopidogrel 75 mg daily
  35. CHADS2 score of > 2
    • high risk for stroke
    • oral anticoag
    •   pradaxa 150mg BID
    •   warfarin INR 2-3
    •    aspirin (75-325mg) + clopidogrel 75mg QD
  36. long term AAD therapy w/ no structural heart disease
    flecainide, propafenone, sotalol
  37. long term AAD therapy w/ heart failure
    amiodarone or fodetilide
  38. long term AAD therapy w/ coronary heart disease
    sotalol
  39. long term AAD therapy w/ HTN and significant LVH
    amiodarone
  40. long term AAD therapy w/ HTN and not LVH
    flecainide, flecainide, sotalol
  41. the most effective agent & the most frequently used in long term AAD therapy
    amiodarone
  42. sotalol's use in long term AAD therapy
    not effective for conversion of AF, but it is an effective drug for maintaining SR
  43. drug that is contraindicated for advanced HF
    • droneradone
    • propafenone
  44. non-pharm Tx of choice for severe symptomatic PSVT
    synchronized DCC
  45. non-pharm Tx of mild to moderate symptoms with PSVT
    • vagal techniques
    •   unilateral carotid sinus massage
    •   valsalva maneuver
    •   ice water facial immersion
    •   induced retching
  46. pharmacologic Tx of PSVT with digoxin MOA
    directly or indirectly increase vagal tone to the AV node
  47. pharmacologic Tx of PSVT with adenosine MOA
    depress conduction through slow, calcium dependent channels
  48. pharmacologic Tx of PSVT with class 1A & flecainide MOA
    depress conduction through fast, sodium dependent tissue
  49. Tx of automatic atrial tachycardias in symptomatic pts to control ventricular rate
    • verapamil
    • diltiazem
  50. Tx of automatic atrial tachycardias in symptomatic pts to restore SR
    • procainamide
    • quinidine
  51. what drugs are CI in the Tx of automatic atrial tachycardia
    beta blockers
  52. Tx of symptomatic PVC's
    beta blockers
  53. what drug classes are CI for the Tx of PVC's
    I & III
  54. definition of monomorphic VT
    > 3 consecutive PVC's occurring at a rae > 100 beats/min
  55. 4 causes of monomorphic VT
    • metabolic abnormalities - hypo K or Mg
    • ischemia
    • drug toxicity - digoxin
    • chronically recur as a paroxysmal fomr
  56. Tx of acute monomorphic VT with severe symptoms (HoTN, angina, pulmonary edema)
    synchronized DCC
  57. Tx of acute monomorphic VT with mild symptoms
    • procainamide
    • amiodarone
    • sotalol
    • synchronized DCC
  58. conservative Tx for nonsustained VT
    beta blocker
  59. empiric Tx for nonsustained VT
    amiodarone
  60. aggressive Tx for nonsustained VT
    ICD
  61. supraventricular arrhythmias
    • atrial fibrillation
    • atrial flutter
    • paroxysmal supraventricular tachycardia PSVT
    • automatic atrial tachycardia
  62. ventricular arrhythmias
    • premature ventricular complexes PVC
    • ventricular tachycardia
    •   monomorphic
    •   polymorphic (TdP)
    • ventricular fibrillation
  63. bradyarrhythmias
    Atrioventricular (block AV block)

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