Notes in arrythmias

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Status	Last Update	Fields
Published	09/08/2024	{{c1::chronotropic}}: changes HR via alterations in automaticity (think SA node)
Published	09/08/2024	{{c1::Dromotropic}} changes heart electrical conduction speed (think AV node)
Published	09/08/2024	{{c1::Inotropic}}: changes heart contractility (think ventricular myocytes)
Published	09/08/2024	Ventricular action potential: phase matches with {{c1::QRS}}, driven by {{c1::electrolytes}} (mainly sodium, potassium, and calcium) Each ch…
Published	09/08/2024	Vaughan Williams Classification:Class I: {{c1::sodium}} channel blocking agents, mainly phase {{c1::0}}Class II: {{c2::beta blockers}}, phase{{c2…
Published	09/08/2024	Ordering antiarrhythmics is like ordering from door dash:Double quarter pounds; lettuce, mayo, pickles; fries please! → Class Ia:  {{c1…
Published	09/08/2024	Vaughan Williams Classification: a great starting point for meds but has 2 large holes: fails to classify other meds outside of those listed channels …
Published	09/08/2024	Class I Antiarrhythmics are separated into subclasses a, b, and c based on {{c1::affinity}} to {{c1::receptor}}. Medications from diffe…
Published	09/08/2024	MOA of class 1 antiarrythmics:Effects slope of phase {{c1::0}} via {{c1::sodium}} channelsNegative {{c2:: dromotropic}} effec…
Published	09/08/2024	Class 1a: {{c1::Disopyramide}}: Comes in immediate release and delayed release formulas (delayed release preferred for adherence and better …
Published	09/08/2024	indications for class 1A: {{c2::disopyramide }}{{c1::SVTVT/fibAF/flutter}}
Published	09/08/2024	indications for class 1a: {{c1::Quinidine}}SVTVT/fibAF/flutterMalaria
Published	09/08/2024	indications for class 1a {{c1::Procainamide}}:SVTVT/fibAF/flutterCan be used for stable, wide complex tachycardia
Published	09/08/2024	indications for class 1b: {{c1::Lidocaine (IV)}}VT/fib usually after MI(no effect on atrial tissue)
Published	09/08/2024	indications for class 1b: {{c1::Mexiletine}}VT/fibDoes not prolong QT interval (great for pts subject to torsades)
Published	09/08/2024	indications for class 1b: {{c1:: Phenytoin}}VT/fibCan be used for suppression of ventricular arrhythmias, digoxin induced arrhythmias, and Afib (…
Published	09/08/2024	indications for class 1c: {{c1::Flecainide}}SVTAF/flutterParticularly useful for WPW syndrome
Published	09/08/2024	DO NOT USE {{c1::PHENYTOIN}}
Published	09/08/2024	indications for class 1c: {{c1::propafenone }}SVTAF/flutter
Published	09/08/2024	{{c1::Quinidine}} comes in 3 different salt forms with different amounts of active drug:Sulfate (83%)Gluconate (62%)Polygalacturonate (60%)
Published	09/08/2024	{{c1::Procainamide}} is an active metabolite (N-acetylprocainamide) has VW class III effects (also works on {{c2::K+}} channel). Can be bolus or …
Published	09/08/2024	{{c1::Lidocaine}} (IV) has a high affinity for {{c2::ischemic}} tissue (↑ pH)
Published	09/08/2024	{{c1::Mexiletine}} is an oral analogue of lidocaine (cannot send pts home on IV lidocaine so switch to this)
Published	09/08/2024	{{c1::Flecainide}} is NOT to be used in pts with {{c2::structural heart}} disease or heart {{c2::failure}} (will cause torsades)Do not routinely treat…
Published	09/08/2024	{{c1::Propafenone}} has more impact on HR than flecainide, could take PRN if patients know they are going into A fib
Published	09/08/2024	{{c2::Disopyramide}} has better long term side effect profile:Negative {{c4::inotrope}}{{c3::Anticholinergic}} side effects (don’t use in {{…
Published	09/08/2024	{{c1::Quinidine}} has limited usefulness given adverse effects:HypotensionConduction abnormalitiesWorsening arrhythmiasTorsadesCinchonism (tinnit…
Published	09/08/2024	{{c1::Procainamide}} has serious acute & long term side effects:Acute: severe hypotension, torsadesLong term: lupus-like syndromes, agranuloc…
Published	09/08/2024	{{c1::Lidocaine}} toxicity:Usually if serum level > 5 mcg/mLConfusion, sedation, lethargy (binds to Na+ channels in brain)
Published	09/08/2024	Mexiletine needs caution in {{c1::hepatic}} impairment or overt {{c1::HF}}
Published	09/08/2024	Lidocaine (IV) is highly {{c1::hepatically}} metabolized (don’t give to {{c1::liver}} pts)
Published	09/08/2024	{{c1::Mexiletine}} dosing is often limited by GI side effects or adherence to TID medications
Published	09/08/2024	{{c4::Propafenone}} is {{c1::hepatically}} metabolized. NOT to be used in pts with {{c2::structural heart}} disease or heart {{c3::failure}}…
Published	09/08/2024	Includes all beta blockers EXCEPT {{c1::sotalol}}
Published	09/08/2024	Beta Blockers are used for {{c1::rate control}} for all arrhythmias
Published	09/08/2024	BB MOA: {{c1::Negative}} dromotropic effect via {{c2::AV}} node
Published	09/08/2024	BBs have {{c1::lipophilicity}}: usually hepatically metabolized and shorter half-life, may have better mortality outcomes than other agents
Published	09/08/2024	Metabolic effects of BBs: {{c1::↓}} insulin sensitivity, {{c2::↑}} incidence of new {{c3::diabetes}}, weight {{c3::gain}…
Published	09/08/2024	BBs have intrinsic {{c1::sympathomimetic}} activity (ISA): ɑ activity {{c2::lowers}} BP more than other agents
Published	09/08/2024	{{c1::Esmolol}} (β1 selective) indications are:Sinus tachAfib/flutterSVTVT/fibTitratable drip
Published	09/08/2024	{{c1::Carvedilol}} / {{c1::Labetalol}} (ɑ1β1β2) indications are: Sinus tachAfib/flutterSVTVT/fibSome alpha activity so better beta bloc…
Published	09/08/2024	labetalol has more {{c1::β1}} activity than carvedilol
Published	09/08/2024	Carvedilol is more {{c1::lipophilic}} than labetolol
Published	09/08/2024	carvedilol has a {{c1::longer}} half life (7-10hr) than labetolol
Published	09/08/2024	{{c3::Propranolol}} is {{c1::not}} selective. It has a {{c2::high}} liophilicity so can penetrate the CNS.
Published	09/08/2024	{{c1::Propranolol}} is indicated for:Sinus tachAfib/flutterSVTVT/fib
Published	09/08/2024	Class {{c1::III}} Antiarrhythmics MOA: prolongs {{c2::refractory}} period in both atria and ventricles via {{c3::K+}} channel…
Published	09/08/2024	{{c1::Amiodarone}} has a variety of effects:Beta blockerNa+ / Ca++ / K+ channel blockerContains iodine → thyroid issues / ocular deposits
Published	09/08/2024	{{c1::Sotalol}} MOA: Beta blocking and K+ channel blocking effects
Published	09/08/2024	{{c1::Amiodarone}} has a wide use in both atrial and ventricular arrhythmias
Published	09/08/2024	{{c1::Amiodarone}} is the preferred drug for HF
Published	09/08/2024	{{c1::Amiodarone}} has LOTS of drug interactions: warfarin, statins, digoxin, HIV meds, etc. Not good for younger patients (consider lifetim…
Published	09/08/2024	Acute treatment with amiodarone: ACLS algorithm, {{c2::150}} mg for VT with a pulse, {{c1::300}} mg for pulseless VT/VF (reason: diluen…
Published	09/08/2024	Maintenance therapy of amiodarone: use {{c1::minimum}} dose possible to suppress arrhythmias, start at {{c2::200}} mg daily for at…
Published	09/08/2024	{{c1::Dronedarone}} is uncommonly used d/t the ANDROMEDA trial (in pts with severe HF or LV dysfunction, increased risk of early mortality relate…
Published	09/08/2024	{{c1::Dofetilide}} is a very good antiarrhythmic (good efficacy, less total adverse effects). Safe to use in pts with existing HF. Use limit…
Published	09/08/2024	{{c3::Dofetilide}} requires more acute monitoring. It has very serious drug-drug interactions: thiazides, ACEi, trimethoprim (bactrim), -azo…
Published	09/08/2024	{{c1::Dofetilide}} is one of the most potent drugs in regards to QT prolongation → torsades (best practice is to admit pt for initial 6 doses to …
Published	09/08/2024	{{c1::Sotalol}} is mostly for atrial arrhythmias, Afib/flutter, SVT. SWORD trial: oral d-{{c1::sotalol}} associated with increased…
Published	09/08/2024	Sotalol needs dose adjust for {{c1::renal}} issues. Don’t use in pts with recent {{c2::MI}} or {{c2::HF}}
Published	09/08/2024	{{c2::sotalol}} has a large impact on {{c1::QTc}} (less than dofetilide): best practice is to admit to hospital for 3 day initiation si…
Published	09/08/2024	{{c1::Ibutilide}} (IV) is mostly used for chemical cardioversion but likely will not use in practice.
Published	09/08/2024	{{c1::Verapamil}} and {{c1::diltiazem}} are negative inotropes, chronotropes, AND dromotropic
Published	09/08/2024	{{c1::verapamil}} and {{c1::diltiazem}} are mostly used for atrial arrhythmias, Afib/flutter, Sinus tach, and SVT. They are available IV and…
Published	09/08/2024	{{c2::NDHP CCBs}} are hepatically metabolized and have several significant CYP interactions. NOT to be used in {{c1::HFrEF}} (will decrease {{c1::EF}}…
Published	09/08/2024	{{c1::Adenosine}} is a AV nodal blocking agent
Published	09/08/2024	{{c1::Adenosine}} has a very short half life, administer with 20 mL NaCl, push as quick as possible. It is indicated for {{c2::PSVT}} (acute)
Published	09/08/2024	Adenosine will make the ECG look like {{c1::asystole}} for a few seconds
Published	09/08/2024	{{c1::Caffeine}} intake can inhibit the effectiveness of adenosine
Published	09/08/2024	{{c1::adenosine}} is metabolized enzymatically in RBCs and vascular endothelium
Published	09/08/2024	{{c1::Atropine}} blocks vagal nerve, increases conduction through AV node and increases HR
Published	09/08/2024	{{c1::Atropine}} ACLS dosing: 1mg Q3-5 min (max dose 3mg)
Published	09/08/2024	{{c1::atropine}} is used in bradycardia and AV block
Published	09/08/2024	do not use atropine in patients with {{c1::glaucoma}}
Published	09/08/2024	{{c1::Digoxin}} increases vagal tone producing negative {{c3::chronotropic}} and negative {{c3::dromotropic}} effect BUT is a…
Published	09/08/2024	{{c1::Digoxin}} is an inhibitor of Na/K ATPase pump causing depolarization (important pump for membrane potential)
Published	09/08/2024	{{c1::digoxin}} is mostly used for rate control in atrial arrhythmias, can concert rhythms as well
Published	09/08/2024	The therapeutic serum concentration of {{c1::digoxin}} depends on indication (not very useful)
Published	09/08/2024	Digoxin toxicity:Serum levels >2 mcg/mLS/Sx:ECG “{{c1::swoop}}”, high grade {{c2::AV}} block, {{c3::ventricular}} tachyarr…
Published	09/08/2024	{{c1::CAST I and II}}: cardiac arrhythmia suppression trialLooked at suppression of PVCs after AMI with class 1c antiarrhythmics (flecainide, ecanaide…
Published	09/08/2024	{{c1::CASCADE}} Trial: cardiac arrest in seattle- conventional versus amiodarone drug evaluation studySurvivors of out of hospital VF arrest (wit…
Published	09/08/2024	{{c1::CAMIAT/EMIAT:}} canadian amiodarone MI arrhythmia trial / european MI amiodarone trialPatients with LVEF < 40% with PVCs or NSVT after M…
Published	09/08/2024	{{c1::PROCAMIO}} trial: lidocaine vs procainamide in the treatment of stable wide complex VT (Can use both)
Published	09/08/2024	{{c1::AFFIRM}} trial: rate vs rhythm control trialPatients 65 years or older who had risk factors for stroke or death, randomized to either rate …
Published	09/08/2024	{{c1::EAST-AFNET4}} trial:Patients with newly diagnosed (past 12 years)) who were 75 years or older with history of TIA/stroke OR 2 of the following: …
Published	09/08/2024	Rhythm or rate control?Treat the {{c1::patient}}!Consider the side effect profile of meds and other comorbidities?Do you REALLY want to put a {{c2::yo…
Published	09/08/2024	Goals of therapy for A fib:Reduce risk of {{c1::stroke}}If CHA2DS2VASc ≥ 2, should be {{c2::anticoagulated}} (DOAC preferred over warfarin if pos…
Published	09/08/2024	goals of therapy for acute ventricular tachycardia or fibrillation:{{c1::Amiodarone}} as the mainstay of therapy{{c2::Lidocaine}}is possible (bet…
Published	09/08/2024	goals of therapy for Tachycardia with a pulse:Wide complex: {{c1::amiodarone}}* or {{c2::procainamide }}Narrow complex: {{c3::adenosine}}*, …
Published	09/08/2024	Maintenance therapy:If controlled acutely on IV therapy, need to convert to {{c1::oral}}Ideally, stay within the same class/mechanismAmio → …
Published	09/08/2024	Ventricular arrhythmias: follow ACLS, {{c1::amiodarone}} is the correct choice 90% of the time
Published	09/08/2024	Atrial fibrillation: multiple right strategies, consider {{c1::rhythm control}} first if high risk of {{c2::stroke}} or severely impaired
Published	09/08/2024	Dont forget to replete your {{c2::magnesium}} and {{c2::potassium}} to mitigate {{c1::torsades}} risk
Published	09/08/2024	Watch for drug interactions with {{c1::amiodarone}} and {{c2::dofetilide}}
Status	Last Update	Fields