Antiarrhytmics (Lesson 7 - How to Choose the Right Med and Classic Pitfalls)

Рет қаралды 56,518

7 жыл бұрын

A discussion of how to choose the right antiarrhythmic to rate control and pharmacologically cardiovert atrial fibrillation and atrial flutter, as well as converting and prevention of ventricular tachycardia. An overall summary of this series is also presented.

Пікірлер: 51

@e1nherjar1 5 жыл бұрын

I have watched the whole series probably like 5-7 times. I am doing a residency in Cardiology and this is still the best place to understand antiarrhytmics! Thank you for your effort dr. Strong!

@folumb 6 жыл бұрын

I knew it was worth saving these videos until 4th year! I didn't get everything, but I understood so much more with the benefit of having all my core clerkships done

@dr.derbyallen7063 2 жыл бұрын

Frankly explained, thank you Dr. Eric .

@thienpham4006 3 жыл бұрын

This topic was really hard for me. Your teachings really helped me. Thank you so much :)

@sunving 4 жыл бұрын

Thank you Dr Strong, especially the advise that this should be done with or by cardiologist,

@draungaungphyo2843 3 жыл бұрын

Thanks a lot for the video which is so beneficial.Your 10 minute video is clearer than a day long lectures and self reading of guidelines from AHA,RCP,NICE etc.Don't stop your work.Keep on your uploads if there is any updated guideline or recommandation.

@paulenus2098 7 жыл бұрын

thank you for these wonderful Videos Eric. i practice medicine in Germany, hier are the drugs we use a little bit different, but still, your Videos help a lot to understand the subtile things than one can not easily find in medicine books. please, keep up the good work. best educational youtube channel i know :).

@mohammedalolabi499 Ай бұрын

You’re such a great teacher

@sunving 3 жыл бұрын

Thank you Dr Strong.

@agnieszkasoteljackson7475 6 жыл бұрын

Fantastic video! Thank you

@bpearl2052 3 жыл бұрын

Thanks for these! Sending to my classmates and probably my professor as well

@josephpremanandan8021 3 жыл бұрын

very very instructive videos and i enjoyed them,

@Attitude397 4 жыл бұрын

Excellent videos 👍 make everything really easy

@valman008 3 жыл бұрын

Thank you for sharing!

@kheirallahmongyadel995 5 жыл бұрын

Awesome channel

@pnm1941 6 жыл бұрын

V well advised. Thank you.

@user-lv6gc5gw4w 4 ай бұрын

Thank you, very helpful

@aaf1985 7 жыл бұрын

Thanks so much You're awesome

@BillKonstantakos 5 жыл бұрын

Why does the third pitfall only involve the atrial flutter? Is there a difference in the mentioned mechanism between A-fib and A-flutter? For example, if we could say with certainty that it is just A-fib, would the management be different (beta blocker not needed)? Also, the propafenone class II activity isn't so strong to be considered adequate, right? Great series overall! Thank you!

@tenchiioun2656 4 жыл бұрын

Thank u for amazing videos... I have Q for u.. If pt with high risk profile of IHD came with Af with RVR and C /O chest tightness..and cTn +ve. I wanna to Know how to deal with this case.. Is It unstable Af and terminal it electrically and explain the +ve cTn as myocardial injury or deal with it as type 2 mi and after termination gove pt routin mx...?

@pauliusmui7455 4 жыл бұрын

pretty amazing series. i think i recall you mention doing diabetes drug video, but have not been able to find it.

@StrongMed 4 жыл бұрын

I'm sorry, I had gotten distracted by a need to cover other topics. Still hoping to get to it...

@sreedharpingili3162 6 жыл бұрын

Great lectures on Arrythmias. Thanks a lot. Please do lectures on heart failure, hypertensive urgency and emergency.

@StrongMed 6 жыл бұрын

I have a video on hypertensive emergency/urgency here: kzfaq.info/get/bejne/l8-Ri9Kmp5q1ook.html I hope to post some heart failure videos over the next year, but unfortunately there are a lot of other competing requests.

@bhishma99 7 жыл бұрын

Thanks alot!!

@muhammedalieksi9716 9 ай бұрын

Thank you

@martareissantos9158 5 жыл бұрын

Hy Dr. Strong. Thank you for you're great video, it was very helpful! I was only left with one question: in patients who have heart failure, the drug of choice to maintain sinus rhythm after cardioversion is, as you said, amiodarone (or dofetilide). As you shouldn't give amiodarone for a long period of time because of its side effects, how long do you keep this therapy? And when you stop it, do you change it for other in order to maintain sinus rhythm? Thank you so much once again!

@StrongMed 5 жыл бұрын

There's no specific rule, but it depends on how reversible the trigger was for atrial fibrillation. For example, a-fib triggered by cardiac surgery is extremely common, and I typically see patients cardioverted immediately, and placed on amio for 1 month post-op before having it stopped, followed by a 2 week ambulatory ECG monitor to make sure it hasn't recurred. Whereas in another patient who has advanced heart failure and a massive left atrium in whom the risk of returning to a-fib after cardioversion will always be high - that patient might stay on amio for years (i.e. effectively for life) if they can't tolerate being in a-fib and if other antiarrhythmics are felt to be contraindicated, even despite the long term risks from amio. From my experience (i.e. what I see done by the cardiologists with whom I work), it's uncommon to switch from amio to a different med for maintaining sinus rhythm in patients with advanced heart failure, unless toxicity has developed. But also, there's a lot of nuance to prescribing antiarrhythmics, and we often don't know for certain what the right approach is for any particular patient. So you'll find a lot of variability in med choices among cardiologists in practice.

@martareissantos9158 5 жыл бұрын

@@StrongMed That was enlightening, thank you so much!

@tahbriz 7 жыл бұрын

thanks!

@shif442 7 жыл бұрын

another great video but I have a qyestion regarding a certain point in it:you specify the quinidine is treatment for recurrent vf in brugada syndrom. do you think that a question on that issue can apear in the ABIM exam or is more likely to appear in the cardiology board?

@StrongMed 7 жыл бұрын

I would be very very surprised if the ABIM exam asked about quinidine's use in Brugada syndrome.

@Lloyd.B 3 жыл бұрын

Thanks for the video! What is your stance on Multaq when not dealing with permanent af?

@brianbarber7285 2 жыл бұрын

I'm curious about the same thing. I've had two doctors evaluate me and they both prescribed Multaq.

@mezoa3775 7 жыл бұрын

helpful

@veyzh_ 7 жыл бұрын

Eric Strong make a update with the cool bed on you're channel . Lie, what's inside that secret room and etc. I hope you do it because I'm really interested in that 800+ $ bed

@StrongMed 7 жыл бұрын

Honestly, the secret room isn't very exciting. Just a bunch random toys on the floor. I'm probably going to be building another bed for my daughter next year. Will make another IKEA hack video then.

@veyzh_ 7 жыл бұрын

Strong Medicine oh .... Then for your daughter are you gonna made the ikea hack bed differently so she fells special . Just collide the things she likes/loves. Like you did with your son. Probably she likes some book or movie and you can work with that . But anyways , gonna wait for that 2018 Eric Strong IKEA hack #2 video for your Daughter .

@tenchiioun2656 4 жыл бұрын

Thank u Dr strong. I have question for u. If 66yo man known case of HTN. DCM with EF 44% came with Af with RVR (HR 140bpm)>48Hr. His BP 110/60..serum. Cr 1.6..urea.66.in this case which drug should be used to control the rate..?and in case i Use digoxin to control the rate.. As u said its dangerius in pt with unstable renal function (is there cut point for that after which i can Use it)

@jab376 3 жыл бұрын

Tenchii oun . He said he doesnt give individual medical advice. Read disclaimer. This is for Educational purposes only.

@nsas955 3 жыл бұрын

Great and simple explanation. Thank you .But please remove the writing on a black background of your speech because it covers the slide information.

@StrongMed 3 жыл бұрын

Thanks for the comment. I think the writing you're referring to is the closed captioning for hearing-impaired viewers that KZfaq adds automatically. You can turn off this setting by clicking the tiny CC button in the lower right corner of the viewer.

@kidaz Жыл бұрын

Might help to mention SWORD trial where sotalol INCREASED death in LVSD.

@StrongMed Жыл бұрын

Thanks for the comment. In SWORD (published 1996), patients with hx of MI + EF

@kidaz Жыл бұрын

@@StrongMed You're amazing. Thank you for your comprehensive comment and crisp videos, I salute you. Because of SWORD, Sotalol (and Flec with CAST) makes it hard for any EP to justify their use in SHD. Your logic of modern GDMT offering protective BB is sound, but unproven with additional Sotalol in RCT. So many old trial results might need to be scrapped too due to ungeneralisability to our good GDMT today.

@61arunajonnalagadda36 4 жыл бұрын

Are you a cardiologist

@StrongMed 4 жыл бұрын

Nope - I'm a hospitalist with a strong interest in cardiology (and who is coincidentally married to one).

@amiyambbs273 7 жыл бұрын

sir, please give english subtitle

@StrongMed 7 жыл бұрын

English subtitles were just posted for this video. I haven't used KZfaq automatic subtitle generator before (using an uploaded transcript). Please let me know if there are any problems. I'll try to go back and do the same for as many videos as I can.

@amiyambbs273 7 жыл бұрын

thanks, it will be very much helpful as you want to help us

@Hesbonful 4 жыл бұрын

Hi Mr Amiyakalyan, am grateful that you got English subtitles. Likewise, encourage many of the Indian descent persons to use English or use English subtitles. The frustration is equally the same with so many Indian KZfaq clips advertised in English but the whole conversation is not in English... Thanks 🙏