Atrial fibralation/flutter
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| arrhythmias | abnormal rate/rhythm
a rhythm other than normal (50-100BPM)
🗑
|
||||
| supraventricular arrhythmias | originates above AV node
not immediately life-threatening
🗑
|
||||
| types of supraventricular arrhythmias | sinus tachy/bradycardias
atrial fibralation/flutter
paroxysmal supraventricular arrhythmia
🗑
|
||||
| paroxysmal supraventricular arrhythmia | by pass tract reentry
🗑
|
||||
| ventricular arrhythmias | originates below AV node
can be life threatening (worsening cardiac output)
🗑
|
||||
| types of ventricular arrhythmias | premature ventricular contraction
non-sustained ventricular tachycardia
sustained ventricular tachycardia
(Torsades de Pointe)
cardiac arrest (V fib, sudden cardiac death, asystole)
🗑
|
||||
| atrial fibralation | most common type of arrhythmia
increased risk with age
(2%>22 5%>65 10%>80y/o)
🗑
|
||||
| causes of A Fib | HTN, valvular heart disease, HF, thyroidtoxicosis, hypoxia, pericarditis, post-cardiothoracc surgery, CAD(rare)
🗑
|
||||
| s/sx of a fib | palpitations, dizziness/syncope, HF, SOB, cardiac arrest
🗑
|
||||
| SA + AV node drugs | usually CCBs and BBs
🗑
|
||||
| atrial and ventricular muscle drugs | usually Na and K channel blockers
some BBs
🗑
|
||||
| SA + AV nodes | slow conduction channels
🗑
|
||||
| atrial + ventricular muscle | fast conduction channels
🗑
|
||||
| class 1 antiarrhythmics | Na channel blockers
🗑
|
||||
| class 2 antiarrhythmics | beta blockers
🗑
|
||||
| class 3 antiarrhythmics | K channel blockers
🗑
|
||||
| class 4 antiarrhythmics | Ca channel blockers
🗑
|
||||
| nodal drugs | class II and IV
🗑
|
||||
| muscular drugs | class I, II, and III
🗑
|
||||
| if patient is not hemodynamically stable | electrocardioversion
🗑
|
||||
| fast rhythm countering drugs | class I and IV
🗑
|
||||
| slow rhythm countering drugs | atropine, isoproterenol or pacemaker
🗑
|
||||
| ventricular rate vs. ventricular rhythm | CONTROL RATE FIRST!
🗑
|
||||
| ventricular arrhythmias | control rhythm (class I or III)
🗑
|
||||
| digoxin effects on arrhythmias | slows heart rate by enhancing PANS activity centrally
🗑
|
||||
| adenosine effects on arrhythmias | strong AV nodal blocker
short half life
rapid bolus followed by saline flush to ensure drug gets to heart as active drug
🗑
|
||||
| atrial flutter Tx | same as atrial fibralation but pts. are more likely to undergo ablation (destruction/errosion of cells or tissue)
🗑
|
||||
| pharmacotheraputic goals of atrial fibralation Tx | ventricular rate control
prevention of thromboembolic events
rhythm control (back to NSR)
🗑
|
||||
| ventricular rate control drugs | reduce AV nodal conduction/prevent fast atrial beats from reaching the ventricles
🗑
|
||||
| ventricular rate control drugs | BBs, CCBs(verapamil/diltiazem only), and digoxin
(adenosine can work as well but is too short acting to be continuously effective)
🗑
|
||||
| rate control in a fib needs to be achieved within | 48 hours of onset
🗑
|
||||
| when is rhythm control initiated | when we are sure the pt. is properly protected from thromboembolic events
🗑
|
||||
| digoxin adv. | will treat CHF concurrently
🗑
|
||||
| digoxin disadv. | slow onsset (several hours) ineffective with increase of sympathetic activity
🗑
|
||||
| CCB adv. | fast onset, effective
🗑
|
||||
| CCB disadv. | may worsen CHF
may cause hypotension
🗑
|
||||
| BB adv. | fast onset, effective
effective in post-operative A fib
🗑
|
||||
| BB disadv. | cantraindicated in pts. with asthma, COPD
may worsen CHF symptoms
may cause hypotension
🗑
|
||||
| rate control agent should be used until: | patient restores normal sinus rhythm
🗑
|
||||
| rate control agents should not be used indefinately if NSR is not achieved | rate control agents should not be used indefinately if NSR is not achieved
🗑
|
||||
| amiodarone for ventricular rate control | in pts. w/ LVD or HF
in pts. that can not use other agents
🗑
|
||||
| amiodarone is | primarily a K channel blocker but also has BB and CCB properties
(BEWARE OF CONVERTING PT. TO NSR)
🗑
|
||||
| a FIB >48 HOURS | high risk for thromboembolus
Tx LMWH bridged w/ warfarin
low risk pts. may not need bridging
🗑
|
||||
| warfarin therapy in a fib | continued until NSR is restored then continue for an additional month
🗑
|
||||
| use anticoags 4 weeks before and after cardioversion back to NSR | use anticoags 4 weeks before and after cardioversion back to NSR
🗑
|
||||
| CHADS2 score for ASA Px of thromboembolism (CHADS2 must be lower than 2 to treat with ASA) | CHF +1
HTN +1
age>70 +1
diabetes +1
stroke +2
🗑
|
||||
| after cardiversion use ___ to maintain NSR | Na or K channel blockers
🗑
|
||||
| choosing NSR restoring/maintaining agents | onset of action (IV or PO)
duration of therapy (amiodarone is a lifetime drug with harsh side effects)
liver/renal fxn (renal-procainamide, sotalol, dofetilide)
🗑
|
||||
| more NSR restoring/maintaining agent choices | left ventricular function (LVEF<40% use amiodarone, prefered, or dofetilide only 2 that don't inc. mortality)
Hx of CAD or MI (use lidocaine or amiodarone only 2 that don't inc. mortality)
🗑
|
||||
| antiarrhythmic drug interactions | anything prolonging QT causes Torsades
amiodarone & digoxin, quinidine, verapamil
dofetilide & HCTZ, cimetadine, triamterine, ketoconazole, megesterol, prochlorperazine, tromethoprim, verapamil
🗑
|
||||
| only use class 1c if: | pt. has no other cardiac structural abnormality due to high risk of torsades
🗑
|
||||
| class 1a agents: | no longer used due to high recurrence of a fib
🗑
|
||||
| antiarrhythmic therapy is continued until: | cause of a fib is reversible
🗑
|
||||
| antiarrhythmic agents are usually more effective in: | new onset a fib, not chronic a fib
🗑
|
||||
| if recurrance of a fib/flutter | optimize dosing and compliance
check risk factors
cardiovert and continue therapy
if all antiarrhythmic agents fail vontinue ventricular rate control and anticoagulation
consider ablation therapy (eps in flutter)
🗑
|
||||
| treatment endpoints | NSR = 50-100BPM
BP = 130/80
no thromboemolic events
if on warfarin INR 2-3
🗑
|
||||
| monitoring for a fib pts. | ECG, HR, BP, side effects of drugs used
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
lex86
Popular Science sets