Cardiovascular
Cardiac Arrhythmias (Note Sheet)
Drugs and measures for common arrhythmias. The sheet is a compact set of student notes and is only partly legible; check against a cardiology source.
- ICD-10
- —
- Source
- OPD handbook p.215 (top band of a handwritten student sheet; some lines are cut off)
- Status
- Draft
Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.
Symptoms
Treatment
Step 1 of 8
Sinus bradycardia
- Treat only if symptomatic: Inj Atropine 1 mg, ½ ampoule IV
- If there is no response: ventricular pacing
Step 2 of 8
Atrial ectopics
- Treat if symptomatic: Tab Lexilium 3 mg (bromazepam), half a tablet 6-hourly
- If there is no response: Tab Concor (bisoprolol) 5 mg OD, or Tab Calan 40 mg BD (verapamil)
Step 3 of 8
Ventricular ectopics
- Tab Lexilium 3 mg
- If no response: Tab Concor 5 mg
Step 4 of 8
Paroxysmal ventricular tachycardia
- No IHD, hypotension; first try carotid sinus massage
- If not effective: Inj Calan (verapamil) (line cut off)
Step 5 of 8
WPW syndrome with supraventricular tachycardia
- Prophylaxis: Tab Procainamide 250 mg TID, or Flecainide tab 100 mg, or Tab Bisoprolol 5 mg OD
- Acute: Inj Inderal (propranolol) 1 mg/amp, or Inj digoxin 0.5 mg/2 mL amp diluted in 20 mL 5% dextrose; Tab Calan 40 mg TID, Tab Concor 5 mg OD, or Tab Lanoxin 0.25 mg TID to control rate when not urgent
- Medical cardioversion: Inj Tambocor (flecainide) 10 mg/mL or Inj Pronestyl (procainamide); if recurrent, Tab Sedacoron (amiodarone) 100 mg TID (2 weeks)
Step 6 of 8
WPW syndrome with atrial fibrillation (acute)
- Rate above 160/min: electrical cardioversion
- Rate below 140/min: Xylocaine 2% solution bolus 1 mg/kg followed by 0.5 mg/kg
- Prophylaxis: Tab Procainamide 250 mg; Tab Flecainide 100 mg BD
Step 7 of 8
Ventricular tachycardia
- Unstable patient: immediate cardioversion
- Stable patient: Xylocaine (lignocaine) 2% solution, 1 mg/kg bolus followed by 0.5 mg/kg bolus every 10 minutes
- Chronic therapy: Tab Procainamide 250 mg TID; if refractory: Tab Amiodarone 100 mg TID
Step 8 of 8
Atrial flutter / fibrillation
- Heparinise before and after (3 weeks) cardioversion
- Unstable patient: electrical cardioversion
- Stable patient (control rate): IV in emergency, Inj Calan (verapamil) 2.5–5 mg IV over 2–3 minutes
- If angina, hypotension or heart failure: DC cardioversion
- Prophylaxis: Tab Calan 40 mg BD, or Tab Concor 5 mg OD, or Tab Lanoxin 0.25 mg OD; if not controlled: Tab Pronestyl 250 mg TID or Tab Tambocor 100 mg BD
Medicines named on this page
- Procainamide (Pronestyl), flecainide (Tambocor), amiodarone (Sedacoron / Cordarone), digoxin (Lanoxin), verapamil (Calan), bisoprolol (Concor), propranolol (Inderal), atropine, lidocaine (Xylocaine), bromazepam (Lexilium).