Arrythmias

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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
      • 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
      • Cardioversion
        • Pharmaco-logical
          • Amiodarone or flecainide
        • Electrical
      • 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
  • 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
    • For conc. assay, take level 6hrs after dose

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