- ATRIAL FLUTTER CAUSES DURING PREGNANCY HOW TO
- ATRIAL FLUTTER CAUSES DURING PREGNANCY FULL
- ATRIAL FLUTTER CAUSES DURING PREGNANCY PLUS
Amiodarone may subsequently be continued until the patient has recovered from their critical illness (e.g., for 1-2 weeks). Pre- and post-treatment with amiodarone may promote successful and sustained cardioversion.For example, DC cardioversion will often transiently elicit normal sinus rhythm, with a subsequent reversion into atrial fibrillation. Among critically ill patients, DC cardioversion alone usually fails to achieve sustained sinus rhythm.Pre & post-treatment with anti-arrhythmic
ATRIAL FLUTTER CAUSES DURING PREGNANCY HOW TO
How to perform electrical cardioversion for atrial fibrillation or flutter in critical illness If a patient with AF and an accessory pathway is displaying instability, proceeding directly to DC cardioversion is indicated.
This is a unique situation where DC cardioversion is usually the treatment of choice (based on its efficacy and speed). Antiarrhythmics which may be used are procainamide or ibutilide. Blockade of the AV node may merely cause a greater dominance of the accessory pathway, exacerbating matters (to a certain extent, the AV node and the accessory pathway are competing for control of the ventricle). beta-blockers, calcium channel blockers, or amiodarone). AF with an accessory tract shouldn't be treated with medications that impair the AV node (eg. Morphology varies between different beats (some beats are fusion complexes if the AV node and the accessory pathway fire at a similar time). Wide-complex beats can result from transmission over the accessory pathway. Irregularly irregular heart rate that may be extremely fast (e.g. AF with an accessory pathway produces a fairly distinctive pattern of EKG findings:. This is dangerous because the extremely fast and uncoordinated contractions of the ventricle can promote ventricular tachycardia or cardiovascular collapse. (1) Heart rate: As a general rule, heart rates 200). Some key pieces of information can help:. The key question is: What is driving the instability? Is the atrial fibrillation causing the patient to be unstable? Or is atrial fibrillation merely triggered by underlying instability?. How much is AF actually contributing to the patient's instability? TSH should be considered if there is no obvious cause of AF, or if other clinical features suggest thyrotoxicosis. If there is other evidence suggesting PE, CT angiography may be indicated. If thoughtful review of EKG and history suggests ischemia, then obtain troponin. Additional tests as clinically warranted. Review of the presence of any indwelling cardiac devices. Pneumonia, COPD, hypoxemia, hypercapnia. Primary neurologic disorders (e.g., intracranial hemorrhage, ischemic stroke). Beta-agonists (norepinephrine, epinephrine, dobutamine, etc.). Substance use (especially cocaine, amphetamine, methamphetamine). Electrolyte abnormalities (especially hypokalemia and hypomagnesemia). 
Be careful when cardioverting patients with a heart rate <100, as there may be an increased risk of bradycardia. If the heart rate is <100, conduction disease is likely. ATRIAL FLUTTER CAUSES DURING PREGNANCY PLUS
If the heart rate is >200, consider the possibility of an accessory tract (AF plus Wolff Parkinson White).For most patients who aren't on medications that suppress the AV node, AF will have a heart rate of ~120-180.(One exception to these criteria is that if AF is combined with heart block, then the ventricular response may be regular.).Also consider comparison to P wave morphology in prior EKGs (if the patient previously had large, well-defined P-waves and now they're gone, then this supports an AF diagnosis). If it is unclear whether there are P waves or fibrillation waves, consider obtaining a Lewis Lead EKG.In some patients, fibrillation waves may be small and difficult to distinguish from artifact.Fibrillation waves may be best seen in the inferior and right-sided precordial leads.No P waves are seen instead these may be replaced by fibrillation waves.When in doubt, calipers may help determine whether there is any regularity.At very high rates, the heart rate may appear to be regular (“pseudo-regularization”).
ATRIAL FLUTTER CAUSES DURING PREGNANCY FULL
AF diagnosis should always be confirmed with a full 12-lead EKG.AF may be suspected on the basis of an irregularly irregular heart rate (either on clinical examination or telemetry).
0 kommentar(er)
