Arrythmias
- Created by: Melissaloughlin
- Created on: 19-04-23 22:04
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- Arrhythmias
- Atrial Fibrillation
- SOB, dizziness/ syncope, palpitations, chest discomfort
- Use CHA2DS2-VASc for stroke risk
- Anti-coagulation (DOACs) - score >2
- Edoxaban (Lixiana) 30mg/60mg OD
- Apixaban (Eliquis) 5mg/2.5mg BD
- Anti-coagulation (DOACs) - score >2
- Rhythm control post-cardioversion
- For pt's still symptomatic after rate is controlled
- Beta-blocker 1st line (not sotalol)
- 2nd line amiodarone, flecainide, propafenone, sotalol
- amiodarone & dronedarone blocks multiple ion channels to prevent action potentials
- Dronedarone if persistant/ paroxysmal AF
- Consider amiodarone for pt. with LV impairment or HF (flecainide & propafenone contra indicated)
- Paroxysmal AF
- pill-in-pocket strategy considered
- Take medication only when an episode starts
- Intermittent episodes that terminate within 7 days
- pill-in-pocket strategy considered
- Cardioversion
- Pharmaco-logical
- Amiodarone or flecainide
- Electrical
- Pharmaco-logical
- Tachy arrythmia due to irregular, disorganised electrical activity
- Atrial Flutter
- Should be treated the same as atrial fibrillation
- Drug treatment usually responds less to atrial flutter
- Atria beat regularly but faster than usual and more often than the ventricles
- Torsade de Pointes
- Ventricular tachycardia - Complication of prolonged QT interval
- Contributing meds: Erythromycin, Clarithro mycin, Fluconazole Citalopram, Domperidone Ondansetron, Methadone, Amiodarone, Flecainide, Risperidone, Haloperidol, Clozapine, Imipramine, Amitriptyline & more
- Life-threatening
- Other contributing factors: Hypo-kalaemia Genetic predisposition Severe bradycardia
- Atrial Fibrillation
- Amiodarone: Long half life (several weeks) - OD dosing, Nausea in high doses unless divided, Weeks/ months to reach steady-state
- Hepato toxicity
- Thyroid Function Disorders
- Pulmonary Toxicity
- Corneal Micro-deposits
- Digoxin
- Toxicity
- Nausea & Vomiting
- Lethargy, Confusion
- Hyper-kalaemia
- Visual disturbances
- Hyper-kalaemia
- Lethargy, Confusion
- Nausea & Vomiting
- For conc. assay, take level 6hrs after dose
- Toxicity
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