ANTI-ARRHYTHMIC DRUGS
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***SAMPLE AFIB WORK SHEET***
HPI:
**Document the Following:
-History of CAD / MI / PCI / CABG?
-If so, list what symptoms they presented with (CP? SOB?) , what hospital they went to, what work did they have (TTE? Cath?)
-History of Afib:
-How did they present? How was it diagnosed?
-What symptoms do they have from Afib? (LH/dizziness, palpitations, racing heart rate sensation, syncope, pre-syncope, chest pain, dyspnea, fatigue, CHF etc)
-How were they treated? (Ever have a DCCV? Placed on any AAD or anticoagulation?)
ASSESSMENT & PLAN:
1. [Put classification of Afib here] Atrial Fibrillation:
(a) [Classification]: The patient has new onset (or diagnosis) AFib / Paroxysmal / Persistent / Long Standing Persistent / Permanent AFib (recurrent?)
(b) [Put date of initial diagnosis here]: Initial diagnosis was _______
***If this is new onset / new diagnosis Afib --> demonstrate that you have gone through secondary causes of Afib here:
(c) [List Symptoms] Patient is asymptomatic / symptomatic with his/her Atrial fibrillation (list symptoms here if applicable i.e.: LH, dizziness, palpitations, dyspnea etc)
--> If symptomatic: How symptomatic is it? Is it activity limiting? Do they have to stop what they are doing? Is it debilitating?
(d) [Time Line]: Patient’s time line is as follows: (starting from initial diagnosis, list times and dates of DCCVs, history of AAD, and AFib ablations). Below is a sample time line:
Initial Diagnosis ECG 4.14.2017: AFib
TTE 4.14.17: LVEF ~ 30% (while in a fib)
TEE-DCCV 4.19.17: AFib --> NSR
---> Started on Sotalol 4.19.17
TTE 6.4.17: LVEF ~ 55% (in sinus rhythm)
ECG 12.1.17: Recurrence of AFib
Ambulatory Monitor December 2017: Persistence AFib with 100% Afib Burden
PVI 1.9.18: Successful Afib ablation
(e) [Treatment]: Treatment Plan: Use algorithm above to help formulate a plan. Here is a sample:
-Patient is currently maintaining sinus rhythm on sotalol 120 mg po BID and doing well.
-eGFR > 60 ----> continue BID dosing
-ECG (list date of ECG) showed Normal Sinus Rhythm @ 62 bpm and QTc = 442 sec
(e) [Anticoagulation] In regards to anticoagulation, the patient’s CHADS2-VASc score is ____
-List last Hemoglobin level here