21- Arial Fibrillation Flashcards
t or f: atrial fibrillation is a greater burden on female population
true
but a greater % of men are affected
what does D-dimer indicaate?
active indicatior of clot formationa nd clot lyssi
describe a CHADS2 score
C- CHF H - HTN A- age greater than 75 D- diabetes S- secondary pt with prior ischemic strok of TIA
score indicates risk of stroke (thromboembolic risk)
increasing score indicates a decreasing NNT
describe NNT
number needed to treat to prevent one stroke per year with X drug
classify: atrial fibrillation episodes which last 1-7 days and may be recurrent
paroxysmal AF
classify: AF that is not self-limited and lasts for longer than 7 days
persistent AF
if over a year it is call long standing persistent AF
AF in a youn, glow risk, CHADS 2-0
lone AF
5 pathophysiologies of atrial fibrillation
- atrial enlargement
- ischemia
- toxins
- metabolic disease
- hemodynamic impairment (loss of atrial addition to SV or tachyarrhythmia)
irregularly irregular pulse –>
a. fib
variable intensity S1 –> a fib. why?
because varying stroke volume with the different contractions and therefore filling time
what is a crucial diagnostic tool for a. fib?
echocardiography
can reveal valvular disease, chamber enlargement or intracardiac thrombi
most common thromboembolism
nonvalvular afib
~50%
is the risk of stoke increased or decreased with lone afib?
decreased. it is low ~1%
4 consequences of a. fib
- thromboembolism
- diminished CO
- ischemic events
- exercise capacity diminution
non-valvular causes of a. fib
- age > 65
- HTN
- rheumatic heart disease
- prior stroke of TIA
- DM
- CHF
treatment goals of a. fib
rhythm and rate control
goal of rhythm control
restore/ maintain sinus rhythm
goal of rate control
maintain acceptable ventricualr rate in chronic A. fib
which is better: rate or rhythm control
?
no survival advantage with either strategy
rhythm control have more adverse drug problems
what is the primary choice for rhythm control
DC conversion. pharmacologic tx is less succesful and a secondary choice
goal HR for rate control of a. fib
80-100 bpm
common agents for acute rate control
beta blockers (metoprolol) and Ca2+ channel blockers (verapamil or ditiazem)
when are antithrombotics not indicated?
if udner 60 yo or a lone A. fib
what does NOAC stand for?
novel oral anticoagulant
