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PHAR 6251 Cardiology Module Atrial and Ventricular Arrhythmias

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  PHAR 6251 Cardiology Module Atrial and Ventricular ArrhythmiasSessions 35-38 10/21-22/2014  Learning Objectives  Upon completion of the reading assignment the student should be able to :1. Explain the normal physiology and propagation of electrical impulses to the heart and be able to explainthem in terms of how they affect the ECG.a. In particular, it is important to know about automaticity, where impulses srcinate, and how they are propagated throughout cardiac tissue. b. Know what is happening mechanically throughout the heart during different sections of the ECG.2. Explain the following pathophysiologic mechanisms underlying the major arrhythmias: abnormalautomaticity, reentry and triggered activity.a. Know the three basic mechanisms by which arrhythmias are propagated. b. Be able to distinguish between atrial, supra-ventricular, and ventricular arrhythmias and be able torecognize ECG tracings that are characteristic of each.c. Know the risk factors for arrythmias.3. Classify the antiarrhythmic drugs according to the Vaughan-Williams system.a. Be able to match the drugs to the classes, e.g. lidocaine is a class ___ agent. b. Know the basic mechanisms of the different classes.4. Characterize each class of antiarrhythmic drug according to effects on ion channels and basicelectrophysiologic outcomes.5. Compare and contrast the side effect profile of individual antiarrhythmic drugs.a. Especially know how to monitor for adverse effects of the antiarrhythmics. Some of them have veryspecific monitoring parameters.6. List the factors that would guide selection of a specific antiarrhythmic drug for an individual patient.a. Know what Vaughan-Williams class of drug is indicated for the various supra-ventricular andventricular arrhythmias. b. Adverse effects are very important for guiding drug selection.c. Drug interactions are very important for guiding drug selection.7. Describe the goals of treatment for each of the following arrhythmias: atrial fibrillation/flutter, paroxysmal supraventricular tachycardia and recurrent ventricular tachycardia.a. Do not forget about global risk reduction (i.e. lipid therapy, hypertension therapy, etc.). It is stillimportant.8. Describe the impact that major clinical trials (e.g. CAST, AFFIRM) have had on the treatment of atrialand ventricular arrhythmias.a. Know the objectives (what questions they were trying to answer) of each. b. Know the major outcomes (the answers to the questions) of each.9. Identify the risk factors for stroke in atrial fibrillation and develop an appropriate antithrombotic treatmentregimen for an individual patient with this arrhythmia.a. And remember that warfarin is no longer the only option available and in some cases will not be the best option.10. Outline an algorithm for the acute treatment of torsades de pointes based upon current recommendations.11. Discuss the role of nonpharmacological therapies (e.g. radiofrequency catheter ablation, implantablecardioverter-defibrillators) for the treatment of arrhythmias.12. Differentiate between the major types of life-threatening proarrhythmia.a. Selection of a drug that worsens the ECG defect (e.g. prolonging an already prolonged QT interval)is potentially fatal.13. List risk factors for developing incessant ventricular tachycardia induced by type Ic antiarrhythmics.  PHAR 6251 Cardiology Module Atrial and Ventricular ArrhythmiasSessions 35-38 10/21-22/2014 14. List the drugs that are known to prolong repolarization and the QT interval and to cause Torsades de pointes.a. Be able to recognize Torsades on the ECG.i. As an aside, two of your classmates participated in the Emergency Department simulation event last Spring at Wright State School of Medicine (I can’t remember specifically who). They did not recognize Torsades on the ECG, but they recognized that the patient was onmultiple drugs that prolonged the QT interval and could cause Torsades. I thought this wasoutstanding that we had P1s that were that clinically astute. So, fist-bump to those two!15. Characterize the electrocardiographic characteristics and predisposing factors for the various types of atrioventricular block.16. Formulate a treatment plan for vasovagal syncope, carotid hypersensitivity, and the different forms of atrioventricular block.  Readings 1. Pharmacotherapya. Chapter 8. The Arrhythmiasi. Sections:(1) For Sessions 33-34(a) The Arrhythmias: Introduction(b) Arrhythmogenesis(c) Antiarrhythmic Drugs(d) Supraventricular Arrhythmias(2) For Sessions 35-36(a) Ventricular Arrhythmias(b) Bradyarrhythmias(c) Evaluation of Therapeutic and Economic Outcomes b. 2 Cardiovascular Pharmacotherapyi. For Sessions 33-34(1) Ch. 11 Atrial Arrhythmiasii. For Sessions 35-36(1) Ch. 12 Ventricular Arrhythmias and Related Emergency Cardiovascular Care Pharmacotherapy: A Pathophysiologic Approach, 9 Ed. (Available on AccessPharmacy)   Cardiovascular Pharmacotherapy: A Point of Care Guide.
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