Patient with SVT
"Patient with HR 160"
Get EKG
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SVT
aFib
(aFlutter)
- on boards, HR > 150, regular
- on boards, HR < 150, IRR
- Chaotic baseline, sawtooth
aFib
HDS?
unstable = shock
Rate control
CCC = BB
w/ RVR
A Fib Risk Factors
- Age
- ~ 10% of patients > 80
- < 1% patients < 55
- F > M
- Associated with HTN, CAD
- Anything that dilates atria
- HF
- Valvular disease
- Dx structure abnormality with echo
- Pts with hyperthyroidism
- New aFib should have TSH levels
A Fib triggers
- Often no trigger identified
- Binge drinking
- Increased catecholamines
- Infection
- Surgery
- Pain
A Fib Tx
- Rate control
- HR < 110
- BB
- B1 selective (metoprolol, Atenolol)
- Ca Blocker
- Verapamil, diltiazem
- Digoxin (increases parasympathetic tone)
- BB
- HR < 110
- Rhythm control
- Electrical
- Chemical
- Ibutilide (class III)
- Spontaneous
- Common when d/t infection
- Anticoagulation
All slow conduction through AV node
AFFIRM trial: No mortality difference between rate and rhythm control
Cardioversion
- Risk of stroke
- Data that 48 hours for thrombus formation
- If sxs > 48 hours, anticoagulate and wait 3 weeks
- Exception: hypotension/shock
Anticoagulation
- Likely anticoagulate pts who develop aFib
- Even if sinus rhythm restored
- CHADS VASC Score
Score 0-1 = Aspirin or no therapy
Score >= 2, Warfarin or other AC
New Onset aFib
Echo
TSH
Rate Control
Anticoagulation
Rhythm control
Pulomonary vein isolation
Atrial Flutter
Atrial Flutter
- Very similar to aFib
- Can be asymptomatic
- tx the same way
- aFlutter ablation
Thank You!
and happy dyngus day!