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Arrhythmias (Tachycardias (Atrial Fibrillation (Causes (Cardio: HTN, ACS,…
Arrhythmias
Tachycardias
SVT
Non-pharmacological: Valsalva, ice pack on face, carotid sinus massage
Pharmacological: Adenosine (slow AV node conduction) OR Verapamil (increase depolarisation time at node)
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Atrial Fibrillation
Stable
Rhythm control (new onset): (1st) pharmacological- Flecanide, Sotalol, Amiodarone, Procainamide; (2nd) cardioversion
Rate control (if chronic AF): beta blocker, digoxin, magnesium, CCB
CARDIOVERSION: > 48 hours- must anticoagulate w/ warfarin (2-3 wks) OR LMWH + echo (If no clot: can cardiovert immediately). Continue warfarin for 4 wks post cardioversion
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Causes
Cardio: HTN, ACS, valvular disease
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Respiratory: PE, pericarditis, pericardial trauma
Endocrine: thyrioid, phaeochromocytoma, DM
ECG
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No identifiable P waves, atrial rate > 400 but ventricular rate 75-175
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Ventricular Tachycardia
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If stable = chemical cardioversion w/ Amiodarone OR Procainamide OR Sotalol OR Lignocaine; if above fails = cardioversion
If Torsades = MgSO4 bolus 2g IV, defib
Bradycardias
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Sinus bradycardia
Symptomatic OR HR < 40 = Atropine 0.5-1mg IV (only useful for narrow complex bradycardia) or temporary/permanent pacemaker
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Narrow + Regular: SVT, atrial flutter, WPW
Narrow + Irregular: Afib, variable Aflutter
Wide + Regular: ventricular tachy, sinus tachy with BBB
Wide + Irregular: VF, VT, AF with BBB