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]], 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.

=Congestive Heart Failure=

=Congestive Heart Failure=