Ebook Cardiology emergencies: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Cardiology emergencies: Part 2
Ebook Cardiology emergencies: Part 2
CHAPTER 8 Arrhythmias88Symptomatic AF with Mild-Moderate Hemodynamic CompromiseVentricular rate 100-150 bpm, breathless and/or mild hypotension. Consi Ebook Cardiology emergencies: Part 2ider other causes for hemodynamic compromise, e.g. sepsis.Onset <48 hours•Heparin (start at 80 units/kg followed by 18 units/kg/h), or low molecular weight heparin.•Consider pharmacological cardioversion with amiodarone (150 mg IV bolus followed by 1 mg/kg/h drip over 6 hours followed by a 0.5 mg/mi Ebook Cardiology emergencies: Part 2n maintenance drip).•If the patient has good hemodynamics, no pulmonary edema, and no known structural heart disease (no previous ischemic heart diseaEbook Cardiology emergencies: Part 2
se or valve disease and a normal transthoracic echocardiogram) an alternative to amiodarone is flecainide 150-300 mg po. Plan for electrical cardioverCHAPTER 8 Arrhythmias88Symptomatic AF with Mild-Moderate Hemodynamic CompromiseVentricular rate 100-150 bpm, breathless and/or mild hypotension. Consi Ebook Cardiology emergencies: Part 2te electrical cardioversion is not available, start treatment with amiodarone while waiting.Onset >48 hours•Heparin (start at 80 units/kg followed by 18 units/kg/h), or low molecular weight heparin.•Rate control with one of the following:•Digoxin 500 mcg in 0.9% saline IV over 1 hour or 500 mcg oral Ebook Cardiology emergencies: Part 2ly at 12 hourly intervals for three doses, then 125-250 mcg daily•Beta-blocker, e.g. metoprolol 25-50 mg po bid•Verapamil 40-80 mg po tid•Diltiazem suEbook Cardiology emergencies: Part 2
stained release 60-120 mg po bid•Amiodarone is poorly effective at rapidly controlling rate in AF when given orally, but can be given as an IV bolus (CHAPTER 8 Arrhythmias88Symptomatic AF with Mild-Moderate Hemodynamic CompromiseVentricular rate 100-150 bpm, breathless and/or mild hypotension. Consi Ebook Cardiology emergencies: Part 2nd amiodarone are the drugs of choice for patients with known structural heart disease and impaired left ventricular function•Use caution when combining diltiazem or verapamil with betablockers.Onset <48 hours•Low-molecular weight heparin.•Consider antiarrhythmic medication to minimize the risk of r Ebook Cardiology emergencies: Part 2ecurrent AF post DC cardioversion. It also may restore normal sinus rhythm without the need for cardioversion.•DC cardioversion can be considered withEbook Cardiology emergencies: Part 2
in 48 hours of onset or electively after adequate anticoagulation.Onset >48 hours•Anticoagulation and rate control (if required) initially.•AntiarrhytCHAPTER 8 Arrhythmias88Symptomatic AF with Mild-Moderate Hemodynamic CompromiseVentricular rate 100-150 bpm, breathless and/or mild hypotension. Consi Ebook Cardiology emergencies: Part 2 Management•Echocardiography to look for underlying heart disease•Consider anticoagulation with warfarin, especially if structural heart disease, age >75, hypertension, congestive heart failure, DM, prior stroke or other risk factors for stroke, or if planning outpatient cardioversion in 4 weeks tim Ebook Cardiology emergencies: Part 2e•Future antiarrhythmic strategy to prevent recurrence if previous episodes or presentation with compromising AF.Special Considerations for AF•AttemptEbook Cardiology emergencies: Part 2
to restore NSR sooner rather than later as AF becomes more difficult to suppress when allowed to persist for an extended period of time•AntiarrhythmiCHAPTER 8 Arrhythmias88Symptomatic AF with Mild-Moderate Hemodynamic CompromiseVentricular rate 100-150 bpm, breathless and/or mild hypotension. Consi Ebook Cardiology emergencies: Part 2s and therefore should be selected, dosed, and monitored carefully•Rapid control of ventricular rate in the emergency department or ICU setting may also be achieved with a continuous infusion of the IV beta-blocker esmolol. This has the advantage of being short-acting and can be titrated up and down Ebook Cardiology emergencies: Part 2 depending upon heart rate and blood pressure response•Digoxin as a sole agent can slow the resting ventricular rate, but its effect may be lost onceEbook Cardiology emergencies: Part 2
the patient becomes active and rv-i bx i I <21CHAPTER 8 Arrhythmias88Symptomatic AF with Mild-Moderate Hemodynamic CompromiseVentricular rate 100-150 bpm, breathless and/or mild hypotension. ConsiCHAPTER 8 Arrhythmias88Symptomatic AF with Mild-Moderate Hemodynamic CompromiseVentricular rate 100-150 bpm, breathless and/or mild hypotension. ConsiGọi ngay
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