ILE 8 - afib treatment algorithm.

ILE 8 - afib treatment algorithm
afib is both a
Acute and chronic condition


fib may have rapid ventricular response which can be
life threatening with rapid HR and hemodynamic collapse
Emergency

both acute and chronic require
rate control


rate lowering meds
Rate control- leaving them in afib but slowing HR


rhythm control
restoration of sinus rythym


decision points when doing pt eval
-Cardioversion
-Rate vs rhythm
-Anti-arrhythmic
-Stroke risk
-Anticoag


acute HF can be
Can be asymptomatic, tachycardia or ic about to die, cant talk etc,
severe hypotension, pulmonary edema,


If tachycardic > 110 and symptomatic but can talk
-First goal is to reduce ventricular rate
-Then determine whether to restore rhythm

, If pt symptomatic about to die, cant talk etc, severe hypotension,
pulmonary edema,
Electric cardioversion, do not wait for anti-coagualtion


Selecting an agent for acute rate control
Beta blockers, non-DHP CCB, digoxin, amiodarone


BB and CCb
Faster
Similar efficacy


all agents for acute rate control dosed
iV initially


acute rate control agent choice based on
LV function


in acute rate control, can add on
IV magnesium


NO HF acute rate control agents
1. BB, verapamil or diltizaem- 1st choice
2. digoxin
3. amiodarone


Digoxin impacts
-resting HR but not exercise
-Goal range 0.5-1.2