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Welcome to the 2024 Ohio-ACC FIT Bootcamp
Episode 4: Arrhythmia Differentiation and Management Intro
with Salvatore Savona, MD, FACC
Video Introduction
Dear Ohio-ACC Colleague,
Welcome back to the 2024 Ohio-ACC FIT Bootcamp! Thank you to my co-chair Dr. Marissa Edmiston for hosting the first three episodes. We're delivering to you a series of power-packed emails directly to your inbox, each designed to enhance your knowledge and skills. Here's what you can expect:
- A new, focused topic each week
- Concise, high-yield teaching points
- An exclusive video for in-depth learning
This carefully curated content allows you to learn at your own pace, fitting seamlessly into your busy schedule. This Bootcamp is your launchpad to excellence in cardiology.
Get ready to embark on this exciting journey of growth and discovery. Your fourth episode arrives now!
EPISODE 4
Arrhythmia differentiation is necessary for the appropriate management of patients hospitalized. Arrhythmias will be encountered early on in fellowship training, and it is important to embrace the ECG and become comfortable differentiating arrhythmias. An important point in the management of all arrhythmias is the hemodynamic assessment, as a cardioversion or defibrillation is warranted for an unstable patient. This seminar provides an excellent overview by Dr. Mackall on the differentiation and management of arrhythmias.
Teaching points:
- Arrhythmia mechanisms can be attributed to re-entry or abnormal impulse formation
- The hemodynamic assessment is the first step in the evaluation of a patient with an arrhythmia
- A cardioversion or defibrillation should be performed if there is hemodynamic instability
- If stable, determine narrow complex tachycardia (NCT) or wide complex tachycardia (WCT), as well as regularity to differentiate underlying mechanism
- Many criteria available for VT diagnosis (Brugada), though VA dissociation in consistent with VT
Management
- AF- cardiovert if unstable, acute rate control with beta-blocker or calcium channel blocker, anticoagulate all cardioversions acutely, rhythm control options for chronic management
- MAT- treat underlying cause
- AVNRT- vagal maneuvers, adenosine, ultimately an ablation for long term management
- AVRT- adenosine (have patient on defibrillator given risk of VF if develops AF in patients who have baseline pre-excitation), ultimately an ablation, if pre-excitation at baseline and stable can use procainamide or ibutilide
- AT- rate control, AAD vs ablation
- MMVT- beta-blocker, AADs, cardioversion vs defibrillation
- PMVT/TdP- assess for ischemia, treat underlying cause, increase heart rate if QT prolongation dependent, AAD (avoid QT prolonging medications), electrolyte replacement
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