Cardiac Arrhythmias

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Cardiac Arrhythmias

• John Noviasky, PharmD

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Question 1

• What are common causes of Atrial Fibrillation
  (AF) and Atrial Flutter?
• What are common systemic causes of AF?
• What is lone AF ?

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Question 2

• What is the most common patient complaint in AF?
• What is usual ventricular rate in AF?
• The atrial kick lost due to AF, accounts for
  20-30 of stroke volume. When this is lost,
  common symptoms include?

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Question 2 continued

• Why is the patient with AF at risk for thrombotic
  stroke?
• What concurrent disease states increase the risk
  of stroke (over the five fold increase already
  found with AF)?

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Question 3

• Name 2 primary goals of treatment in AF.
• How are these goals achieved?

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Question 4

• How does digoxin slow the ventricular rate
  response?
• Is digoxin first-line therapy for AF in all
  patients?
• What are limitations to digoxin?

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Question 6

• Beta-Blockers should not be given to this group
  of patients due to negative inotropic effects?
• Beta blockers should be used with caution in this
  group of patients due to effects on Beta-2
  receptors?

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Question 6 continued

• How long do the calcium channel blockers (CCB)
  (verapamil and diltiazem) take to work when given
  via IV route?
• Can calcium be used to alter hemodynamic response
  seen with CCB?

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Question 6 continued

• Which rate-controlling agent is preferred in
  patient with asthma, verapamil or metoprolol?
• What is an alternative rate controlling
  combination when monotherapy is not tolerated?

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Question 7

• Incidence of stroke with and without warfarin?
• When is warfarin recommended?
• How long should patient remain on warfarin after
  cardioversion?

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Question 8

• Name 3 agents that have been used for chemical
  conversion?
• In one study, how many Patients converted with
  ibutilide were in sinus rhythm at hospital
  discharge?

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Question 8 continued

• Main adverse effect of ibutilide?
• Conversion rate and adverse effect of propafenone
  and flecainide?

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Question 11

• When is direct-current (DC) cardioversion
  preferred over chemical conversion?
• When DC conversion is attempted, what agents are
  necessary?
• Should digoxin be held for DC?

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Question 12

• What did the AFFIRM trial tell us about Rate vs
  Rhythm control?

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Question 13

• When should rhythm control be considered?
• Most common adverse event from quinidine?
• What is chinconism?
• In what patients should flecainide be avoided?

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Question 13 continued

• How do the class III agents work?
• Why does patient starting sotalol need to
  hospitalized?
• Which is more effective, amiodarone, quinidine or
  soltalol?

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Question 14

• What is increased risk of stroke in patients with
  nonvalvular and valvular AF?
• When a stroke occurs, how often does it lead to
  death or significant neurologic disability?

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Question 14 continued

• What group of patients did not benefit from
  warfarin in SPAF trial?
• Which patients should be on warfarin ?
• Should a patient in sinus rhythm while on
  anti-arrhythmic, continue on warfarin therapy?

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Question 16

• What is incidence of AF after cardiothoracic (CT)
  surgeries?
• What is mechanism for AF after CT?
• When amiodarone is used as AF prophylaxis, what
  is rate of AF after CT?

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Question 19

• What is the characteristic onset and termination
  of PSVT?
• What are adverse outcomes of PSVT?

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Question 21

• What is the valsalva maneuver?
• What is DOC for PSVT?
• What is half-life of adenosine?

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Question 22

• Common side effects of adenosine?

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Question 23

• What is PSVT conversion rate with verapamil and
  diltiazem?
• When should verapamil be avoided?

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Question 24

• How is PSVT managed on long-term basis?

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Question 26

• Why does verapamil cause VF in patients with
  bypass tract?

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Question 29

• Are occasional PVCs an indication for drug
  therapy?
• What can occur with frequent PVCs?
• What did CAST trial tell us about use of
  anti-arrhythmics?