Introduction with a case
Why did she develop hypotension?
Predicting the hemodynamic effect of cardioversion
Target heart rate for atrial fibrillation patient in septic shock?
Final thoughts on the case
- Hemodynamic improvement after cardioversion is more likely when the initial heart rate is very fast. Patients with a heart rate under 150 b/m are less likely to improve immediately following cardioversion.
- Patients treated with negative chronotrophic agents prior to cardioversion may be pushed in a slow sinus rhythm without the ability to mount a compensatory sinus tachycardia. For patients with severe systolic dysfunction, this can precipitate cardiogenic shock.
- For patients with chronic AF in septic shock, attempting to “normalize” the heart rate will reduce the cardiac output. Such patients may benefit from permissive tachycardia.
Latest posts by Josh Farkas (see all)
- PulmCrit- Rant: Antimicrobial exposure and risk of delirium - December 17, 2018
- IBCC chapter & cast- Adrenal crisis - December 12, 2018
- IBCC chapter & cast:Post-cardiac arrest management - December 5, 2018