Unstable Supraventricular Arrhythmias

Prep for USMLE Forum

» Log in | Register

Forum

Step 1

Match

Prep4USMLE Forum » USMLE Step 2 CK Forum » Internal Medicine Forum

Unstable Supraventricular Arrhythmias

Author

4 Posts

DrVirgo
Forum Hero
avatar

Topics: 1096
Posts: 3,515

06/04/08 - 09:01 PM

In case of SVT, A. flutter or A. fib and the patient is unstable, we have to shock (immediate synchronized cardioversion), however is it necessary to anticoagulate either before or after or both with Warfarin?

In which cases is it necessary to anticoagulate with warfarin preceding and following Cardioversion?

___________________
Our greatest glory is not in never falling, but in rising every time we fall.

janan
Forum Newbie
avatar

Topics: 0
Posts: 44

06/04/08 - 10:12 PM

Well, the protocol is that If the patient is hemodynamically unstable, right away go for a cardioversion( that might be modified with increasing joule power and using simultaneous Ibutilide). If the patient is hemodynamically stable then there are two courses...1) The arrhythmia is known to have lasted lesser than 48hours: you can go for electrical cardioversion.2) The duration of the arrhythmia is not known: In this case one should do A TEE( transesophageal Echocardiogram) to look for any mural thrombus, if there is a thrombus, anticoagulate with warfarin first for a few weeks before and after the cardioversion. If there is, however, no thrombus you can do cardioversion right away smiling face

usmletopper2
Forum Senior

Topics: 32
Posts: 140

06/04/08 - 10:23 PM

from what i have learnt ,the recent concept is not to cardiovert pts with prolonged af,only anticoagulants+rate control ,cardioversion only for unstable pts,for whoom we do not need to anticoagulate before the procedure.

___________________
99/99/no us exp/need visa/not yet certified,

DrVirgo
Forum Hero
avatar

Topics: 1096
Posts: 3,515

07/29/08 - 10:52 AM

usmletopper2 wrote:
from what i have learnt ,the recent concept is not to cardiovert pts with prolonged af,only anticoagulants+rate control ,cardioversion only for unstable pts,for whoom we do not need to anticoagulate before the procedure.

Thats true...
This is according to UW:
For CHRONIC A. Fib there are two ways to decrease the risk of stroke in patients (embolic stroke):
1. Rhythm control with Chemical or Electrical cardioversion*
OR
2. Anticoagulate (w/Warfarin) AND Rate Control (with AV nodal blocking agents -diltiazem, metaprolol, digoxin)

The 2nd one has a better outcome!

*Note: Electrical cardioversion should always be performed w/in 3-4 weeks of anticoaglation in Chronic Afib (>48hrs) w/Warfarin.

___________________
Our greatest glory is not in never falling, but in rising every time we fall.

You don't have permission to post.