Metoprolol or Diltiazem) when presented with RVR If already on a rate control agent (e.g.Avoid Diltiazem with Metoprolol (risk of AV Block).Avoid in WPW Syndrome or other accessory pathway.Bolus: 5 mg IV every 5 minutes up to 3 doses (15 mg).If Hypotension occurs, consider Calcium Gluconate 2 g IV (does not counter AV Block).Avoid in WPW Syndrome or other accessory pathway or if ejection fraction Bolus: In 10-20 mg (or 0.35 mg/kg) increments up to 50 mg IV cummulative total bolus.Metoprolol IV is preferred if ejection fraction More rapid acting, more effective and with less risk of Hypotension than Metoprolol.Diltiazem IV may be preferred from study data.Diltiazem IV is used most commonly for acute rate control in U.S.Consider Metoprolol IV if on a Beta Blocker.Consider Diltiazem IV if on a Calcium Channel Blocker.Acute agent choice is often based on the agent patient is already taking.Consider titratable, short-acting medications (e.g.Consider Calcium Gluconate 2 g IV prior to Diltiazem infusion (without bolus).All rate control agents will decrease Blood Pressure.However Atrial Flutter responds better to cardioversion.Atrial Flutter is more difficult to rate control than Atrial Fibrillation.Exercise caution with rate control agents in Pulmonary Hypertension (dilated right heart).Avoid these agents in WPW Syndrome or other accessory pathway (pre-excitation states).
0 kommentar(er)
