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Supraventricular Arrhythmias
Overview
80
Art/Design
4th Grade
02/10/2014

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Term
400-650 atrial bpm; irregular irregular rhythm; ventricular rate: 120-160 bpm; no identifiable P wave on ECG
Definition
Atrial Fibrillation
Term
~300 atrial bpm; regular rhythm; HR 300, 150, 11, 75, or 60 bpm; sawtooth pattern from atrial waves
Definition
Atrial Flutter
Term
Causes include chronic HTN, mitral stenosis, cardiomyopathy, ischemia, congenital defects, pulmonary HTN, Acute PE
Definition
Atrial Distension
Term
causes include ETOH withdrawal, thyrotoxicosis, sepsis, binge drinking, cocaine/amphetamine, excessive caffeine, theophylline or sympathomimetic use
Definition
High Adrenergic Tone
Term
Atrial arrhythmia classification: acute
Definition
onset within 48 hours
Term
atrial arrhythmia classification: paroxysmal
Definition
begins abruptly and converts to sinus rhythm spontaneously within 7 days
Term
atrial arrhythmia classification: persistent
Definition
duration longer than 7 days and does NOT terminate spontaneously
Term
atrial arrhythmia classification: permanent
Definition
does NOT terminate with pharmacological or electrical conversion attempts
Term
atrial arrhythmia classification: recurrent
Definition
two or more episodes
Term
Rate Control
Definition
beta blockers, non DHP CCB, digoxin
Term
Stroke prevention
Definition
aspirin, warfarin, clopidogrel; dabigatran, rivaroxaban, and apixaban
Term
Rhythm control
Definition
amiodarone, dofetilide, and DCC
Term
beta blockers for rate control
Definition
Atenolol; metoprolol; propranolol; esmolol
Term
decreases sympathetic stimulation of AV node: slows V nodal conduction, decreases impulses transmitted to the ventricles, decreases ventricular response rate
Definition
Beta Blockers
Term
BB indications
Definition
for acute rate control in pts with normal LV fxn; for chronic rate control in pts with normal or impaired LV function; (doses for acute rate control significantly higher than those w/ heart failure); IV is the preferred route for acute management!
Term
beta blockers AEs
Definition
hypotension, bradycardia, AV block, lipid abnormalities, glucose intolerance, mask hypoglycemia symptoms, heart failure exacerbation, fatigue, fluid retention, depression, bronchospasm, sexual dysfunction
Term
CCBs used for rate control
Definition
Diltiazem and Verapamil (non DHP)
Term
first line acute for pts with normal LV function; avoid as chronic therapy in pts with impaired LV function; use for less than 24-48 hrs in acute management; IV therapy should be utilized
Definition
Non-DHP Calcium Channel Blockers
Term
CCB AEs
Definition
hypotension, bradycardia, fluid retention, headache, dizziness, flushing, constipation
Term
CCB cautions and CIs
Definition
sick sinus syndrome; 2nd or 3rd degree AV block; severe hypotension or cardiogenic shock; afib/aflutter with accessory bypass tract; vtach, co-administration w/ IV beta blocker
Term
increases vagal tone to the AV node (vagomimetic activity): prolongs refractory period, decreases number of impulses transmitted to ventricles, decreases ventricular response rate
Definition
Digoxin
Term
Digoxin indications
Definition
delayed onset of action (not for acute control); ideal for chronic control w/ concomitant heart failure; IV reserved for those unable to tolerate PO; doesn't provide rate control in pts w/ exercise induced tachycardia; decrease dose by 50% for concomitant amiodarone therapy
Term
digoxin cardiac toxicities
Definition
ventricular arrhythmias, heart block, bradycardia
Term
digoxin GI toxicities
Definition
anorexia, N/V, abdominal pain
Term
digoxin CNS toxicities
Definition
confusion, agitation, delirium, vision changes
Term
risk factors for digoxin toxicity
Definition
hypokalemia, hypomagnesemia, hypercalcemia, hypothyroidis, interacting meds, renal insufficiency
Term
digoxin therapeutic trough serum level
Definition
1.0-2.0 ng/mL
Term
digoxin cautions and CIs
Definition
2nd and 3rd degree heart block (CI); caution when using: amiodarone, diuretics, ketoconazole, quinidine, spironoclactone, verapamil
Term
Acute control: if ejection fraction at least 40% and asymptomatic
Definition
non DHP CCB, Beta blocker, digoxin
Term
Acute control: if ejection fraction at least 40% and symptomatic
Definition
non DHP CCB; beta blocker
Term
Acute control: if ejection fraction < 40% and asymptomatic
Definition
digoxin, diltiazem, amiodarone, beta blocker
Term
acute control: if ejection fraction < 40% and symptomatic
Definition
amiodarone, digoxin
Term
long term control (after 48 hours) if EF is at least 40%
Definition
non DHP CCB, beta blocker, digoxin
Term
long term control (after 48 hours) if EF is < 40%
Definition
digoxin, beta blocker
Term
significant decrease in cerebrovascular events; higher doses no more effective and have increased risk of bleeding
Definition
Aspirin
Term
Reduces the risk of stroke from approximately 5% to 2.4%
Definition
Vitamin K Antagonists
Term
the standard that attempts to standardize the measurements using an international sensitivity index (ISI)
Definition
International normalized ratio (INR)
Term
measure of the thromboplastins responsiveness using a WHO reference
Definition
international sensitivity index (ISI)
Term
INR goals of 2.5 (2-3)
Definition
prophylaxis of VTE, txt of VTE, atrial fibrillation, AMI, valvular heart disease, prosthetic tissue heart valve
Term
INR goals of 3 (2.5-3.5)
Definition
secondary prevention of AMI, prosthetic mechanical heart valve, patients with + anti-phospholipid antibodies
Term
proved to be significantly more effective in reducing stroke compared to warfarin in A. Fib (RE-LY trial)
Definition
Dabigatran
Term
direct thrombin inhibitor; prodrg; not recommended if CrCl < 15 ml/min
Definition
Dabigatran (Pradaxa)
Term
Dabigatran AEs
Definition
N/V, constipation, pyrexia, wound secretion, hypotension, insomnia, peripheral edema, anemia, dizziness, diarrhea, HA, elevations in AST/ALT
Term
Dabigatran monitoring
Definition
renal function, CBC with differential
Term
shown to be noninferior to warfarin for stroke, decreases stroke
Definition
RIvaroxaban
Term
inhibits factor Xa, reversible, direct and selective; not recommended if CrCl < 15 ml/min
Definition
Rivaroxaban (Xarelto)
Term
Rivaroxaban AEs
Definition
itching, bleeding, thrombocytopenia, anemia, AST/ALT/GGT elevation, wound secretion, extremity pain, muscle spasm, syncope, nausea
Term
Rivaroxaban monitoring
Definition
renal function, CBC, hepatic function
Term
shown to be superior to warfarin for decreasing stroke
Definition
Apixaban
Term
inhibits factor Xa, reversible, direct and selective; not recommended if CrCl < 15 ml/min
Definition
Apixaban (Eliquis)
Term
Apixaban AE
Definition
bleeding, anemia
Term
Apixaban monitoring
Definition
CBC
Term
only symptomatic patients receiving optimal rate control
Definition
should receive anti-arrhythmics
Term
Phase 0
Definition
rapid depolarization
Term
phase 1
Definition
early repolarization
Term
phase 2
Definition
plateau phase
Term
phase 3
Definition
late and rapid repolarization
Term
phase 4
Definition
resting membrane potential (diastolic depolarization)
Term
Rapid Depolarization
Definition
cell receives impulse; rapid Na entry; depolarization
Term
Early Repolarization
Definition
Na channels inactivated; partial repolarization
Term
Plateau Phase
Definition
calcium re-entry; absolute refractory period
Term
Late and Rapid Repolarization
Definition
Rapid potassium exit; relative refractory period
Term
Resting membrane potential
Definition
threshold potential
Term
increase threshold potential, decrease the slop of phase 4, increases the absolute refractory period, shortens the refractoriness
Definition
antiarrhythmics
Term
Vaughan Williams Classification: Ia
Definition
quinidine, procainamide, disopyramide
Term
Vaughan Williams Classification: Ib
Definition
lidocaine, mexilitine
Term
Vaughan Williams Classification: Ic
Definition
Flecainide and propafenone
Term
Vaughan Williams Classification II
Definition
propranolol, esmolol, sotalol
Term
Vaughan Williams Classification III
Definition
Dofetilide, sotalol, and amiodarone
Term
Vaughan Williams Classification IV
Definition
verapamil and diltiazem
Term
Amiodarone: Class I
Definition
Sodium Blocker
Term
Amdiodarone: Class II
Definition
Beta-Blocker
Term
Amiodarone: Class III
Definition
Potassium Blocker
Term
Amiodarone: Class IV
Definition
Calcium Blocker
Term
Amiodarone Acute AEs
Definition
bradycardia, hypotension, QT prolongation; Nausea, constipation; phlebitis (IV only)
Term
Amiodarone Chronic AEs
Definition
bradycardia, AV blocks, QT prolongation; pulmonary fibrosis; corneal microdeposits, blurred vision, optic neuropathylneuritis; nausea and hepatitis; hypo and hyperthyroidism; bruising, photosensitivity, blue-gray discoloration; myopathy
Term
Amiodarone Cautions and CIs
Definition
iodine allergy; second or third degree heart block; bradycardia; prolonged QTc interval; hepatic disease; drug interactions
Term
class III antiarrhythmic; significantly effective in restoring normal sinus rhythm and reducing hospitalization
Definition
Dofetilide
Term
dofetilide AEs
Definition
cardiac (not common): hypotension, bradycardia, QT prolongation, ventricular arrhythmias; Central: syncope, HA, dizziness; GI: nausea, vomiting diarrhea
Term
Dofetilide Cautions and Contraindications
Definition
QTc > 440 msec; CrCl < 20 mL/min; first or second degree heart block; bradycardia
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