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Atrial Fibrillation with RVR - #PHARMFAX

Patients present with a wide range of symptoms with atrial fibrillation with rapid ventricular rate, from mild SOB to severe hypotension and shock.

 

Patients present with a wide range of symptoms with atrial fibrillation with rapid ventricular rate, from mild SOB to severe hypotension and shock. Its important that patients have a prompt evaluation for potential acute management. Having a solid approach to life-threatening complications allows you to clinically reason your way through as your working up the patient. When patients present with AF RVR, patients need to have their hemodyanmics to determine if their stable. When patients are hemodynamically unstable, as represented by severe hypotension and AMS, they need need immediate electrical cardioversion. Most cases of atrial fibrillation are caused by a precipitating event, such as infections or electrolyte abnormalities. These would need to be addressed. Once the patient is deemed in stable AF with RVR, we have two pathways, rhythym and rate control, that are dependent on the onset of patients symptoms and/or anticoagulation status. If onset of symptoms we less than 48 hours or adherent to their anticoagulation regimen, patients can be chemically or electrically cardioverted safely. A common medical used to chemically cardiovert patients is amiodarone. When onset of symptoms are > 48 hours or unknown, rate control is the preferred treatment pathway. This is because the risk of thromboembolic events is increased. For our rate control options, our first line therapies include beta blockers and dihydropyrdrine CCB, such as metoprolol and diltiazem. Avoid these medications in the setting of acute decompensated heart failure. Digoxin can be considered afterwards, but I usually have little hope for it. Shocking someone doesn’t sound very pleasant so we’re going to need a sedative. For more PHARMFAX in the drug bank, comment below, what is your go to procedural sedation agent for cardioversions? Not medical advice. Educational purposes only. No relationships to report. I hope you learned something new today. Think I deserve a tip? Website: https://www.pharmwyze.com/donate Crypto (BTC/ETH/USDC): 0x9edC9b21dC18Da768c714f7f7a844217246bA7a5 Paypal: https://www.paypal.com/donate/?hosted_button_id=XUBQCDKNF4B8U

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