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26 Cards in this Set

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Class I anti-arrhythmics


1) Drug names


2) Indications

1) Quinidine, procainamide, disopyramide


2)Pre-excited atrial fibrillation (procainamide)


Brugada syndrome (quinidine)


SVT, atrial fibrillation


Ventricular arrhythmias

Class IB anti-arrhythmics


1) drug names


2) Indications

Lidocaine, mexiletine


Ventricular arrhythmias

Class IC anti-arrhythmics


1) Drug names


2) Indications

1) Propafenone (Rytmonorm), flecainide


2) Atrial fibrillation, SVT


Ventricular arrhythmias


avoid with CAD or structural heart disease.

Class III anti-arrhythmics


1)drug names


2) indication

Sotalol, difetilide


Atrial fibrillation, atrial flutter, ventricular arrhythmias; avoid in CKD.

Avoid anti-arrhytmics


1) in Structural heart disease


2)in CAD


3) in pre-excitation Afib


4) in CKD


5) in long QT

1) class I


2) class IC: flecainide, propafenone


3) CCB, beta blockers


4) class III


5) class III

Patients on amiodarone require lower doses of

Warfarin, statin and digoxin

3 answers

Sinus bradycardia: Causes

most common intrinsic: aging and myocardial fibrosis


most common extrinsic: drugs


Right coronary ischemia


intracranial HTN


postsurgical scarring


Infiltrative or inflammatory disorders such as sarcoidosis

Permanent pacing indications

Symptomatic bradycardia without reversible cause


Asymptomatic bradycardia with significant pauses (>3 seconds in sinus rhythm) or persistent heart rate <40/minAtrial fibrillation with 5-second pauses


Asymptomatic 3rd degree AVB or Mobitz type 2


Alternating bundle branch block

treatment of SVTs (excluding fib and flutter)

/adenosine, maneuvers, synchronised electroversion


beta blockers and non dihidropyridine CCB to prevent recurrence


ablation to avoid long term treatment of if no repsonse to node blockers


flecainide propafenone can be used if no response to other treatment modalities

types of AVRT:


circuit, ecg, response to adenosine and vagal maneuvers

orthodromic: Av node then accessory pathway, narrow qrs, responds to vagal maneuvers and adenosine


antidromic: accessory then av node, delta wave, doesnt respond to adenosine and vagal maneuvers

when are adenosine and nodal blockers CI in AVRT

antidromic AVRT and atrial fibrillation, it leads to Vfib

risk factor for VF in AVRT

WPW, rapid conduction through accessory pathway, ebstein anomaly, multiple bypass tracts

treatment of AVRT

1st line catheter ablation (EP studies help assess speen of conduction and location)


2nd line antiarrhythmics


nodal blockers only in orthodromic AVRT

oral anticoagulation drugs

warfarin


dabigatran (pradaxa)


rivaroxaban (xarelto)


apixaban (eliquis)

CHA2DSVasc2

1 point for:


HF \ HTN \ DM \ female


vascular disease


age 65 to 74 years.


Two points:


previous stroke/transient ischemic attack/thromboembolic disease


age ≥75 years.


0 (none) 1 (none, asa or OAG) 2 and more (oag)

new OAG


1) compared to warfarin


2) CI


3) Antidote

1) better in decreasing stroke


Less IC bleed, More GI bleed


2) ESRD


3) Idarucizumab

treatment of refractory symptomatic tachy in Afib

AV node ablation + pacemaker

Afib epidemio

In patients older than 40 years, the lifetime risk of atrial fibrillation is 1 in 4.


More than 10% of persons aged 80 years and older have atrial fibrillation.


fivefold increased risk of stroke as well as an increased risk of heart failure and dementia

Afib classification

First detected


Paroxysmal atrial fibrillation starts and stops spontaneously.


Persistent atrial fibrillation lasts for 7 days or more and requires electrical or pharmacologic cardioversion.


Long-standing persistent atrial fibrillation is persistent atrial fibrillation that is more than 1 year in duration.

work up for detected afib

tsh


r\o OSA


TTE to r\o valvulopathy

duration of anticoagulation before cardioversion if afib onset >48 hrs

3 weeks

when is aximal need for anticoagulation in afib

during and 4 weeks after cardioversion

when to avoid CCB in rate control

in ventricular dysfunction

treatment of choice in pre excitated afib

procainamide

Afib pharmacological cardioversion drugs in pts without structural heart disease

flecainide, propafenone, ibutilide

conditons where oral anticoagulation for afib regardless of score

mitral stenosis or rheumatic heart disease


prior systemic embolism


a prosthetic heart valve


left atrial appendage thrombus


hypertrophic cardiomyopathy