Atrial Fibrillation
If unstable
=
synchronised DC cardioversion

Atrial fibrillation + Post PCI for acute coronary syndrome:

Generally patients are given triple therapy (2 antiplatelets + 1 anticoagulant) for
4 weeks-6 months after the event
and
dual therapy (1 antiplatelet + 1 anticoagulant) to complete 12 months

In Atrial Fibrillation, Anticoagulation should be continued for at least 4 weeks after cardioversion.

Many patients need chronic anticoagulation depending on the CHA(2)DS(2)-VASc score.

#ECG

Paroxysmal atrial fibrillation is atrial fibrillation that lasts < 1week having converted spontaneously.

Persistent atrial fibrillation is continuous atrial fibrillation that lasts > 1 week.

Long-standing persistent atrial fibrillation lasts > 1 year, but there is still the possibility of restoring sinus rhythm.

Permanent atrial fibrillation cannot be converted to sinus rhythm

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Slow-Fast (Typical) AVNRT.

Management of AVNRT
-vagal maneuver
-adenosine
-Other agents = calcium-channel blockers, beta-blockers and amiodarone
-DC cardioversion is rarely required

-Catheter ablation may be considered in recurrent episodes not amenable to medical treatment.

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S1Q3T3 is a classic but uncommon ECG finding in Pulmonary Embolism.

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Hypertrophic Obstructive Cardiomyopathy HOCM :

Avoidance of nitrates, diuretics, and angiotensin-converting enzyme (ACE) inhibitors

Wellen's syndrome:

- critical ischaemia of the left anterior descending artery.

- biphasic T waves in the anterior leads
or
- deep symmetrical T wave inversion in leads I and aVL associated with 1mm ST elevation in the chest leads.

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RBBB +
left anterior or posterior hemiblock+ 1st-degree heart block
=
trifasicular block

If symptomatic = Pace Maker

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Ventricular tachycardia:

Drug therapy:

1. amiodarone: ideally administered through a central line
2. lidocaine: use with caution in severe left ventricular impairment
3. procainamide

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Posterior STEMI is suggested by the following changes in V1-3:

1. Horizontal ST depression
2. Tall, broad R waves (>30ms)
3. Upright T waves
4. Dominant R wave (R/S ratio > 1) in V2

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STEMI

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angioedema: may occur up to a year after starting ACE inhibitors .

Ivabradine use => visual disturbances including phosphenes and green luminescence.

Correlation between IVC diameter plus CI and CVP

Acute Respiratory Distress Syndrome (ARDS) ....

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Beta-blocker should not be prescribed with verapamil .

may precipitate severe bradycardia

Digoxin dose should be decreased by 25% to 50% when initiating amiodarone.

Amiodarone, verapamil, quinidine and propafenone may increase serum levels of digoxin.