结论:为了加快文章的发表,AJHP在接受后尽快在线发布手稿。接受的手稿经过同行评审和复制编辑,但在技术格式化和作者打样之前在线发布。这些手稿不是记录的最终版本,将在以后替换为最终文章(按照AJHP样式格式化并由作者证明)。
目的:本文,在由两部分组成的审查中,旨在加强有关心律失常的病理生理学的现有文献,以及急性护理环境中各种循证治疗方法和临床考虑。本系列的第1部分重点介绍房性心律失常。
结论:心律失常在世界范围内普遍存在,并且是急诊科(ED)设置中的常见病症。心房颤动(AF)是全球最常见的心律失常,预计患病率会增加。随着导管定向消融的进展,治疗方法已经随着时间的推移而发展。基于历史性的考验,心率控制一直是长期接受的房颤门诊治疗模式,但是抗心律失常药物的使用通常仍然适用于急性房颤,和ED药剂师应该准备和准备帮助管理。其他房性心律失常包括房扑(AFL),房室结折返性心动过速(AVNRT),房室折返性心动过速(AVRT),由于其独特的病理生理学以及每种方法都需要不同的抗心律失常药的使用方法,因此值得区分。与室性心律失常相比,房性心律失常通常具有更大的血流动力学稳定性,但仍需要根据患者亚组和危险因素进行细微的管理。因为抗心律失常药物也可以是致心律失常的,它们可能会由于不利影响而使患者不稳定,其中许多是黑盒标签警告的焦点,这些警告可能会超出范围并限制治疗方案。心房心律失常的电复律通常是成功的,根据设置和/或血液动力学,经常指出。
结论:心房心律失常起因于多种机制,适当的治疗取决于各种因素。对生理和药理学概念的坚定理解是探索证据支持剂的基础,适应症,和不良反应,以便为患者提供适当的护理。
This article, the first in a 2-part review, aims to reinforce current literature on the pathophysiology of cardiac arrhythmias and various evidence-based treatment approaches and clinical considerations in the acute care setting. Part 1 of this series focuses on atrial arrhythmias.
Arrhythmias are prevalent throughout the world and a common presenting condition in the emergency department (ED) setting. Atrial fibrillation (AF) is the most common arrhythmia worldwide and expected to increase in prevalence. Treatment approaches have evolved over time with advances in catheter-directed ablation. Based on historic trials, heart rate control has been the long-standing accepted outpatient treatment modality for AF, but the use of antiarrhythmics is often still indicated for AF in the acute setting, and ED pharmacists should be prepared and poised to help in AF management. Other atrial arrhythmias include atrial flutter (AFL), atrioventricular nodal reentry tachycardia (AVNRT), and atrioventricular reentrant tachycardia (AVRT), which warrant distinction due to their unique pathophysiology and because each requires a different approach to utilization of antiarrhythmics. Atrial arrhythmias are typically associated with greater hemodynamic stability than ventricular arrhythmias but still require nuanced management according to patient subset and risk factors. Since antiarrhythmics can also be proarrhythmic, they may destabilize the patient due to adverse effects, many of which are the focus of black-box label warnings that can be overreaching and limit treatment options. Electrical cardioversion for atrial arrhythmias is generally successful and, depending on the setting and/or hemodynamics, often indicated.
Atrial arrhythmias arise from a variety of mechanisms, and appropriate treatment depends on various factors. A firm understanding of physiological and pharmacological concepts serves as a foundation for exploring evidence supporting agents, indications, and adverse effects in order to provide appropriate care for patients.