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18 Cards in this Set
- Front
- Back
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How do you classify arrythmias
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Paroxysmal - spontaneous self termination within 7 days of onset
Persistent - lasts more than 7 days Permenant Recurrent - 2 or more episodes |
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How do you use rate control
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1) Ventricular rate control
- Goal HR is 60-80 beats/minute at rest and 90-115 beats/minute during exercise. RACE-2 trial suggests lenient rate control not inferior to strict control Beta blockers - selective beta1 antagonists like atenolol or metoprolol may be preferred. Labetalol or carvedilol if additional alpha blockade is desired (HTN, cocaine). Sotalol or propafenone if rhythm control is necessary 2) NonDHP CCB (verapamil, diltiazem) Avoid use if concomitant systolic dysfunction May be preferred over beta blockade in patients with asthma 3) Digoxin Often ineffective alone for controlling ventricular rate Can be included in regimen if patient has systolic HF May be effective if additional HR control is needed when a patient is receiving beta blocker, diltiazem, or verapamil |
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How do you manage anticoagulation in arrythmia for high risk factors, medium risk factors and low risk factors
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1) High risk factors
Prior stroke, TIA, mitral valve dx, prosthetic heart valve Warfarin INR 2.5 (any high risk factor, > 2 moderate risk factors) 2) Moderate risk factors HTN HF LV dysfunction Older than 75 DM Warfarin or aspirin 81-325mg (one moderate, any weak risk factors) 3) Weak risk factors age>65 female CAD throxtoxicosis No risk factors |
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What is CHADS2
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C - CHF
H - HTN A - AGE>75 D -DM 2 - prior stroke or TIA 2 or greater - high 1 - moderate 0 - low |
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What is the role of clopidogrel trial wise vs aspirin and warfarin
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ACTIVE A trial
Compared with aspirin alone, a combo with clopidogrel for whom warfarin was unsuitable had a decreased risk of CV event, but increased bleeding ACTIVE W trial Warfarin vs combo of plavix/asa, decreased risk of CV events. No diff in bleeding |
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What is the role of dabigatran as a class and ClCr cutoff
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Direct thrombin inhibitor
Do not use with ClCr<15 |
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How do you convert dabigatran from or to parenteral anticoagulants
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Start dabigatran 0-2 hrs before the time of the next dose of the parenteral drug
For patients taking dabigatran, wait 12-24 hours after last dose of dabigatran (depends on ClCr) Do not give with rifampin RE-LY trial showed that dabigatran superior to warfarin at 150mg BID |
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How do you manage rhythm control
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AFFIRM trial showed rhythm control not superior to rate control
If cardioversion is attempted, absence of atrial thrombi must be ensured TEE to visualize atria or 3 or more weeks of therapeutic anticoagulation |
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What oral agents can induce/maintain sinus rhythm
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Class I - contraindicated in HF
Quinidine, disopyramide, propafenone, flecainide (flecainide, propafenone 1st line if no structural heart dx) Class III antiarrhytmics: 1) Amiodarone May increase effects of digoxin, warfarin, beta blockers and statins 2) Sotalol - 50-60% efficacy May be initiated in outpatient Contraindicated in HF and ClCr<40 3) Dofetilide Must be initiated in hospital Renal elimination Safe to use in HF Dronedarone: no pulmonary, thyroid, hepatic and ocular toxicity No need for loading dose Contraindicated in Class II or III HF REMS monitored |
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How do you classify HTN
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Prehypertension: 120-139 OR 80-89
Stage 1: 140-159 OR 90-99 Stage 2: >160 OR >100 |
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What is the treatment goal of BP in DM/CKD vs albuminuria vs HF
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<140/90 except for DM or CKD or albuminuria which is <130/80
HF: <120/80 |
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Beta blockers
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Caution in asthma, COPD
Inhcreased risk of diabetes development May cause depression |
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Thiazides
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May worsen gout
Increased risk of diabetes May assist in management of osteoporosis |
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ACEI/ARB
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Contraindicated in pregnancy and renal artery stenosis
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Aliskiren
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Direct renin antagonist
When combined with losartan, showed renoprotective effects. Questionable if superior to ACEI/ARBP |
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Patients with ischemic heart dx can use what drugs in HTN?
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Potent vasodilators may cause reflex tachycardia, attenuate by using DHP CCB or beta blocker
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African Americans - whats the best drug to use in HTN?
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Use diuretics
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Pregnant patients - what BP drugs to use?
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Methyldopa and hydralazine are safe
Most others are ok to continue except ACEI/ARB |
