11.1 MTB Step 3 - Arrhythmias (A-Fib & A-Flutter) Flashcards
ATRIAL FIBRILLATION (A-FIB)
- What are (2) Physical Signs/Symptoms in a patient with A-Fib?
- What are (3) Disorders found in the History of a patient with A-Fib?
Presentations:
- Palpitations
- Irregular Pulse
Associated Disorders:
- Hypertension (HTN)
- Ischemia
- Cardiomyopathy
ATRIAL FIBRILLATION (A-FIB)
- What is the Best INITIAL Diagnostic Test for A-Fib?
- If the Initial Test is inconclusive for A-Fib, what is the Next Best Test for Inpatients/Outpatients?
- Electrocardiogram (ECG)
-
Next Best Test (if ECG is inconclusive):
- Inpatient = Telemetry monitoring
- Outpatient = Holter monitoring (24-hrs+)
ATRIAL FIBRILLATION (A-FIB)
What are the (3) Simplified Criteria for recognizing A-Fib on ECG?
- Multifocal F-waves replace P-waves at an Atrial Rate of 350 - 650 bpm.
-
Irregular Ventricular response
- R-R Cycle constantly varying.
- If the Ventricular Rate is Rapid, Irregularity is More Difficult to determine.
- Normal QRS
*SOURCE: 12-Lead ECG Interpretation
ATRIAL FIBRILLATION (A-FIB)
Once A-Fib is found on initial diagnostic testing, what are (4) other Tests you should order for CCS Cases?
- Echocardiography: Looking for clots, valve function, and Left Atrial size.
- Thyroid Function Testing: T4 and TSH levels.
- Electrolytes: Potassium, Magnesium, and Calcium levels.
- Troponin or CK-MB: These may be appropriate to test in some acute-onset cases.
ATRIAL FIBRILLATION (A-FIB)
MANAGEMENT
What are (3) Drug Therapies used in STABLE patients with A-Fib, and what is their Mechanism of Action (MOA)?
Drug Therapies:
- Beta Blockers (Metoprolol, Carvedilol)
- Calcium Channel Blockers (Diltiazem)
- Digoxin
MOA:Stable patients should have their Ventricular Heart Rate slowed with one of the following if it is > 100 - 110 bpm. The 3 Drugs above do that.
Give these IV if patients presents in ED
ATRIAL FIBRILLATION (A-FIB)
MANAGEMENT
What is the Treatment for UNSTABLE patients with A-Fib?
Immediate SYNCHRONIZED Electrical Cardioversion
- Done with the first screen, without waiting for TEE or Anticoagulation with heparin or warfarin
ATRIAL FIBRILLATION (A-FIB)
MANAGEMENT
INSTABILITY is defined as having one of which (4) Disorders/Criteria?
- Systolic BP < 90mmHg
- Congestive Heart Failure (CHF)
- Confusion (related to hemodynamic instability)
- Chest Pain
ATRIAL FIBRILLATION (A-FIB)
MANAGEMENT
Once the Rate has been controlled in a patient with A-Fib, what is the Next BEST Step in ALL patients with an Atrial Arrhythmia persisting beyond 2 days?
Anticoagulation
NOTE: If the question does NOT state the duration of the atrial arrhythmia, treat it as if it were persisting beyond 2 days; Anticoagulate
ATRIAL FIBRILLATION (A-FIB)
MANAGEMENT
What are (4) PO Anticoagulants used to treat persistent A-Fib that have similar or better efficacy compared to Warfarin, but without the need to monitor the INR?
- D abigatran
- E doxaban
- A pixaban
- R ivoaroxaban
“DEAR A-Fib”
ATRIAL FIBRILLATION (A-FIB)
ANTICOAGULATION
The Long-Term use of the Combination of which (2) Types of Medications is equal or better than Cardioversion with electricity or medications?
Rate Control Medications
(e.g., Metoprolol, Diltiazem, Digoxin)
+
Anticoagulation
ATRIAL FIBRILLATION (A-FIB)
ANTICOAGULATION
What is a CHADS2 Score and what does the acronym stand for?
CHADS2 is a Scoring System to indicate the Need for Anticoagulation
- C HF
- H ypertension
- A ge > 75
- D iabetes
- S troke/TIA
ATRIAL FIBRILLATION (A-FIB)
ANTICOAGULATION
How is a CHADS2 Scored?
- A CHADS2 Score of 0 or 1 = Aspirin
- A CHADS2 Score of 2 or more = control the Rate and Anticoagulate
Anticoagulation:Warfarinor aNOAC (Apixaban, Dabigatran, Edoxaban, or Rivaroxaban)
- Unlike Warfarin, NOACs do NOT need several days to reach therapeutic levels.
- Even when Warfarin is used for A-Fib, there is NO need to bolus (“bridge”) with heparin.
ATRIAL FIBRILLATION (A-FIB)
ANTICOAGULATION
What is a CHADS-VASc Score and what does the acronym stand for?
CHADS-VASc adds 3 criteria to the CHADS2 Scoring System to indicate the Need for Anticoagulation
- C HF
- H ypertension
- A ge > 75
- D iabetes
- S troke/TIA
- V ascular Disease
- A ge 65 - 74
- S ex (FEMALE)
ATRIAL FIBRILLATION (A-FIB)
ANTICOAGULATION
How is a CHADS-VASc Scored?
A CHADS-VASc is scored the same as a CHADS2:
- A CHADS-VASc Score of 0 or 1 = Aspirin
- A CHADS-VASc Score of 2 or more = control the Rate and Anticoagulate
Anticoagulation:Warfarinor aNOAC (Apixaban, Dabigatran, Edoxaban, or Rivaroxaban)
- Unlike Warfarin, NOACs do NOT need several days to reach therapeutic levels.
- Even when Warfarin is used for A-Fib, there is NO need to bolus (“bridge”) with heparin.
ATRIAL FIBRILLATION (A-FIB)
ANTICOAGULATION
- What is the Mechanism of Action (MOA) for the (3) New Oral AntiCoagulants (NOACs) Apixaban, Rivaroxaban, and Edoxaban?
- What is the Mechanism of Action (MOA) of the New Oral AntiCoagulant (NOAC) Dabigatran?
- Apixaban, Rivaroxaban, Edoxaban = Inhibit Factor Xa
- Dabigatran = Inhibits Thrombin