Changes

**H&P: palpitations, syncope

**H&P: palpitations, syncope

**DDx: [[Sinus tach]], [[Multifocal Atrial Tachycardia]], [[Afib]], [[Aflutter]], [[AVNRT]], [[AVRT]], [[WPW]], [[Vtach]], [[Vfib]], [[Torsades de Pointes]]

**DDx: [[Sinus tach]], [[Multifocal Atrial Tachycardia]], [[Afib]], [[Aflutter]], [[AVNRT]], [[AVRT]], [[WPW]], [[Vtach]], [[Vfib]], [[Torsades de Pointes]]

**Tx: Stable vs. Unstable. Synchronized cardioversion vs DCCV. Vagal maneuvers (blowing into a 20 ml syringe), atropine, [[beta blockers]], [[amiodarone]] '''(Decrease Warfarin by 25% when starting amiodarone)''', digoxin, diltiazem. Rate control superior to rhythm control most of the time. Calculate a CHA2DS2-VASc for Afib patients. Consider cardioablation vs. Watchman. Always get a TEE/cardioversion for chronic Afib. The most effective [[AC]] is warfarin. Best AC is usually DOAC because of once daily oral dosing. LMWH is an alternative if they can't have a DOAC. Aflutter can be 2:1, 3:1, or 4:1 with fixed rates of 150, 100, and 75 respectively. Do NOT shock sinus tach.

**Tx: Stable vs. Unstable. Synchronized cardioversion vs DCCV. Vagal maneuvers (blowing into a 20 ml syringe), atropine, [[beta blockers]], [[amiodarone]] '''(Decrease Warfarin by 25% when starting amiodarone)''', digoxin, diltiazem. Rate control superior to rhythm control most of the time. Calculate a CHA2DS2-VASc for Afib patients. Consider cardioablation vs. Watchman. Always get a TEE/cardioversion for chronic Afib. The most effective [[AC]] is warfarin. Best AC is usually DOAC because of once daily oral dosing. LMWH is an alternative if they can't have a DOAC. Aflutter can be 2:1, 3:1, or 4:1 with fixed rates of 150, 100, and 75 respectively. Do NOT shock sinus tach. '''Treatment for WPW syndrome (ECG findings plus symptoms) is catheter ablation to avoid sudden cardiac death, due to AFib or VFib.'''

=Congestive Heart Failure=

=Congestive Heart Failure=