Atrial fibrillation stable

Stable wide-complex tachycardia with an irregular rhythm o If atrial fibrillation with aberrancy (see Table 1.7)... 

Management of Stable Atrial Fibrillation/Atrial Flutter... 

FIGURE 6-5. Decision algorithm for ventricular rate control using intravenous drug therapy for patients presenting with the first detected episode or an episode of persistent atrial fibrillation that is hemody-namically stable. 

Usual maintenance dose for atrial fibrillation is 200 mg/day (may further decrease dose to 100 mg/day with long-term use if patient clinically stable in order to decrease risk of toxicity) usual maintenance dose for ventricular arrhythmias is 300-400 mg/day. 

Mandapati, R., Skanes, A., Chen, J., Berenfeld, O., and Jalife, J. (2000). Stable Microreentrant Sources as a Mechanism of Atrial Fibrillation in the Isolated Sheep Heart. Circulation 101(2) 194-9. 

Clinical effects A large number of randomized, doubleblind, placebo-controlled trials have shown that the longterm use of (3 blockers improves the clinical status in patients with HF (22-32) (Table 2) and the ACC/AHA guidelines (II) recommend that (3 blockers should be routinely prescribed to all patients with asymptomatic LV dysfunction or stable HF caused by LV systolic dysfunction (unless they have a contraindication or have been shown to be intolerant to treatment with these drugs). (3 blockers should also be used in patients with HF and preserved LV systolic function, particularly when those patients have hypertension, coronary artery disease (CAD) and/or atrial fibrillation. 

A healthy 32-year-old doctor, who smoked marijuana 1-2 times a month, had paroxysmal tachycardia for several months. An electrocardiogram was normal and a Holter recording showed sinus rhythm with isolated supraventricular extra beats. He was treated with propranolol. He later secretly smoked marijuana while undergoing another Holter recording, which showed numerous episodes of paroxysmal atrial tachycardia and atrial fibrillation lasting up to 2 minutes. He abstained from marijuana for 12 months and maintained stable sinus rhythm. 

If the plasma digitalis concentration is below the target range in a patient whose condition is stable (for example atrial fibrillation with a ventricular rate of 80/minute) digitalis can usually be withdrawn safely. 

A 61-year-old woman, who had taken warfarin for atrial fibrillation in weekly doses of 18-19 mg for years and had been completely stable, developed a raised INR after she consumed a tea made from Chinese wolfberry (14). Four days after drinking the tea (180 ml/day), she had an INR of 4.1. After withdrawal of the herbal tea her INR returned to within the target range and remained stable. 

Use PO Treatment of angina due to Half-life Onset Peaks Duration coronary artery spasm (Prinzmetal s 3-8 hours PO 30-60 6-12 h 24 hours variant angina), chronic stable minutes angina (effort-associated angina). IV Immediate Extended release Treatment of essential hypertension and angina. Parenteral Temporary control of rapid ventricular rate in atrial fibrillation/flutter. Rapid conversion of PSVT to normal sinus rhythm. 

An example of this initial dosage scheme is provided in the following case. Mr. PO is a 72-year-old, 83-kg, 5-ft, 11-in man admitted to the hospital for the treatment of community-acquired pneumonia. While in the hospital, Mr. PO develops atrial fibrillation, and the decision is made to treat him with digoxin to provide ventricular rate control. His serum creatinine concentration is 2.5 mg/dL and stable. Calculate an intravenous loading dose and oral maintenance dose that will achieve a Cjj of 1.5 ng/mL. The Cockcroft-Gault equation can be... 

Mandapati R, Skanes A, Chen J, Berenfeld O, Jalife, J. Stable microreentrant sources as a mechanism of atrial fibrillation in the isolated sheep heart. Circulation 2000 101 194-9. 

Stable Strontium. Cardiovascular effects of strontium have been investigated by intravenous infusion studies in dogs. Infusions of strontium (as chloride or gluconate) averaging 172 mg strontium/kg under conditions of lowered potassium induced accelerated ventricular escape beats, ventricular tachycardia, or atrial fibrillation (Foster et al. 1977). High levels of strontium also induced oscillatory potentials and... 

Atrial flutter Stable reentrant circuit in the right atrium Ventricular rate often rapid and irregular Same as atrial fibrillation ... 

In patients with diabetes mellitus, niacin should be used cautiously, since niacin-induced insulin resistance can cause severe hyperglycemia. Niacin use in patients with diabetes mellitus often mandates a change to insulin therapy. If niacin is prescribed for patients with known or suspected diabetes, blood glucose levels should be monitored at least weekly until proven to be stable. Niacin also elevates uric acid levels a history of gout is a relative contraindication for niacin use. Rarer reversible side effects include toxic amblyopia and toxic maculopathy. Atrial tachyarrhythmias and atrial fibrillation have been reported, more commonly in elderly patients. Niacin, at doses used in humans, has been associated with birth defects in animal models and should not be taken by pregnant women. 

Drug overdose Accidental overdose of tiotropium in 74-year-old man with atrial fibrillation resulted in uncontrolled atrial fibrillation, with a ventricular rate of 160/ minute his heart rate had previously been stable at 80-90/minute with metoprolol succinate 50 mg/day [31 ]. 

A 64-year-old man with a 2-day history of bleeding from the rectum became unresponsive. He had taken long-term warfarin because of atrial fibrillation and had received an inactivated influenza vaccine 1 month before admission. The INR was raised, after having been stable for at least 6 months. A CT scan showed a large parenchymal hemorrhagic infarct involving the left temporal, parietal, and occipital lobes. He died about 17 hours after admission. 

In synchronized cardioversion, an electric current is delivered to the heart to correct an arrhythmia. This procedure may be done electively in a stable patient with recurrent atrial fibrillation or urgently in an unstable patient with such arrhythmias as PSVT, atrial flutter, atrial fibrillation, and VT with a pulse. 

Verapamil (80 mg p.o. q. 6 to 8 hours) is indicated in the management of Prinzmetal s or variant angina or unstable or chronic, stable angina pectoris verapamil (0.075 to 0.15 mg/kg rv pnsh over a 2-minnte period) is indicated in the treatment of supraventricnlar tachyarrhythmias verapamil (240 to 480 mg p.o. daily) is indicated in the prevention of recurrent paroxysmal supraventricular tachycardia verapamil (240 to 320 mg p.o. daily) is indicated in the control of the ventricular rate in digitalized patients with chronic atrial flatter and/or fibrillation and verapamil (80 mg p.o. t.i.d.) is indicated in the management of hypertension. 

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