smitha
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44 yo white male comes to ER,with c/o palpitations.He denies any chest pain and SOB. No h/o cardiac ds or risk factors except for mild obesity.He does admits to drinking heavily the night before at an office party.
VS: BP….120/80 mm Hg., ventricular rate is 160bpm.His ECG confirms Atrial fib. with a rapid ventricular response
Wat shud u do at this time/the best next step of management?
Digitalise the pt.
Treat with IV verapamil
Treat with IV procainamide
Cardiovert
Valsalva maneuver.
In this pt. If atrial fibrillation is chronic,Wat is the TOC for prevention of it’s most common complication?
Warfarin
Heparin
Aspirin
Lidocaine
Streptokinase
Wat is the ideal range of the most important lab. Parameter used, in the followup of this pt.?
1. 1.0 to 2.0
2 2.0 to 3.0
3 4.0 to 5.0
4 3.5 to 6.5
5 2.5 to 4.5
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| Delusional
Forum Elite
Topics: 41
Posts: 226
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1 ..... IV Verapamil
2......Warfarin
3......INR 2-3
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| Delusional
Forum Elite
Topics: 41
Posts: 226
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Atrial Fib...........
Short Questions.......
1....What is atrial stunning?
2...What is the cut-off point for anticoagulation?
3...IV Ca++ channel antagonsists are widely used but when are IV beta blockers indicated or IV digoxin?
4...Why shldn't Quinidine be given for cardioversion without rate control?
5...How long should u anticoagulate a patient before and after cardioversion?
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| smitha
Forum Elite
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First of all, abt. the answers for my posts...
Yes del, u r right........the answers........but for the 2nd one, i suggest to go for aspirin in this pt. & not warfarin, coz he has no ther cardiac risk factors but for precipitatio of the cardiac event /AF, due to alcohol binge & this is called" holiday heart" ! So, since anytime u talk, warfarin has & will have chances of bleeding with it's anticoagulation. So, with pt.s having reversible conditions of the cardiac event, or only precipitating factors or men who r <60 yo with no other risks/underlying strl. hrt ds. ASA 325mg /day is the choice........... 
Coming to the ones u posted........
3..... IV digoxin is used in apt. of CCF. and IV beta blockers in a pt. of Torsade de pointes (espplly the congenital one).
4.....might get the pt. into V.fib?
5.....2-3 weeks before the anticoagulation & 3-4 weeks after....and orwl warfarin/asa depending on the case......
and again monthly or even earlier(if u change meds) follow up with INR is warranted!!!!!!!!!!1
I guess i'll post the others later!!!!!!!!
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| smitha
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ok delusional........ i guess, we can use the beta blockers or digoxin IV in apt. of AMI !!!!!!!!!
And iam not sure of that atrial stunning & cut off point for anticoagulation!!!!!!!!!1 
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| shirish_sss
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Posts: 134
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TREATMENT OF CHOICE IN SVT
1) SVT ALL TYPES- CALCIUM CHANNEL BLOCKERS(VERAPAMIL) EXCEPT IN PATIENTS OF AMI, HEART FAILURE AND WPW SYNDROME
2) SVT IN A PATIENT OF AMI - BETA-BLOCKERS PROVIDED THAT THE PATIENT IS NOT IN HEART FAILURE
3) SVT IN A PATIENT WHO HAS AMI PLUS HEART FAILURE OR SVT IN ANY PATIENT WITH HEART FAILURE- DIGOXIN
ALL THE ABOVE THREE DRUGS SLOW DOWN AV CONDUCTION. AND ALL THESE DRUS ARE CONTRAINDICATED IN WPW SYNDROME( WPW SYNDROME IS A TYPE OF RECURRENT RE-ENTRANT ARRYTHMIA WHERE THE PATIENT HAS AN ABNORMAL COMMUNICATION BETWEEN ATRIA AND VENTRICLES- THROUGH WHAT IS CALLED BUNDLE OF KENT ).
AND WE GIVE DIGITALIS BEFORE GIVING QUNIDINE IN A PATIENT OF
ATRIAL FIBRILLATION TO PREVENT VT AND NOT VF.
I HOPE THIS WOULD HELP.
___________________
good
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| smitha
Forum Elite
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Thanx shirish, that definitely was clear &helpful..........
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| smitha
Forum Elite
Topics: 53
Posts: 236
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source of my qs: my own, notes from CMDT, first aid for step1, step3 notes.
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| bakpity
Forum Senior
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Just reviewing old cases and explanations. I spend my whole day checking this site. It is really helpful.
Read the posts>
My opinion is that regarding to the case wrfarin is the TOC in chr. fibrillation.
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