tailieunhanh - Antiarrhythmic Drugs A practical guide – Part 9

Disopyramide, vì hiệu ứng vagolytic của nó, có thể có hiệu quả trong điều trị các giống tương đối phổ biến của rung tâm nhĩ được kích hoạt bởi sự kích thích mạnh mẽ phế vị (chẳng hạn như nuốt chất lỏng lạnh). Cuối cùng, các thuốc chẹn beta có thể có hiệu quả trong việc ngăn ngừa sự tái phát của một số loại rung tâm nhĩ mà dường như được gây ra bởi giai điệu cảm thông tăng. | Treatment of supraventricular tachyarrhythmias 149 Disopyramide because of its vagolytic effects may be effective in treating the relatively uncommon varieties of atrial fibrillation that are triggered by strong vagal stimulation such as swallowing cold liquids . Finally beta blockers may be effective in preventing the recurrence of certain kinds of atrial fibrillation that seem to be induced by increased sympathetic tone. Anticoagulation in atrial fibrillation and atrial flutter Most often preventing stroke should be the doctor s chief goal in treating patients with atrial fibrillation or atrial flutter. The only method that has been shown to reliably reduce the risk of stroke is anticoagulation with warfarin and to a lesser extent with aspirin. Thus when seeing a patient who has atrial fibrillation or atrial flutter the decision as to whether to anticoagulate should always be actively considered. In 2006 the ACC AHA ESC published joint guidelines on the use of chronic antithrombotic therapy in patients with atrial fibrillation or atrial flutter 3 . These guidelines are fairly complex and can be difficult to sort through but in general they can be summarized as follows Patients with atrial fibrillation or atrial flutter can be categorized into one of two groups patients at low risk and patients at high risk for thromboembolism. Those in the low-risk categories should be treated with aspirin 81-325 mg day unless contraindicated. Those in the high-risk categories should be treated with oral anticoagulation in order to produce an INR of unless contraindicated. Determining whether patients fit into a low- or high-risk category depends on two general factors age and the presence of risk factors for thromboembolism. The risk factors include heart failure left ventricular ejection fraction history of hypertension valvular heart disease diabetes and prior history of thromboembolism. Patients in the low-risk category include Age 75 and no risk factors Patients

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