21- Arial Fibrillation

Question 1

t or f: atrial fibrillation is a greater burden on female population

Answer 1

true

but a greater % of men are affected

Question 2

what does D-dimer indicaate?

Answer 2

active indicatior of clot formationa nd clot lyssi

Question 3

describe a CHADS2 score

Answer 3

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

Question 4

describe NNT

Answer 4

number needed to treat to prevent one stroke per year with X drug

Question 5

classify: atrial fibrillation episodes which last 1-7 days and may be recurrent

Answer 5

paroxysmal AF

Question 6

classify: AF that is not self-limited and lasts for longer than 7 days

Answer 6

persistent AF

if over a year it is call long standing persistent AF

Question 7

AF in a youn, glow risk, CHADS 2-0

Answer 7

lone AF

Question 8

5 pathophysiologies of atrial fibrillation

Answer 8

• atrial enlargement
• ischemia
• toxins
• metabolic disease
• hemodynamic impairment (loss of atrial addition to SV or tachyarrhythmia)

Question 9

irregularly irregular pulse –>

Answer 9

a. fib

Question 10

variable intensity S1 –> a fib. why?

Answer 10

because varying stroke volume with the different contractions and therefore filling time

Question 11

what is a crucial diagnostic tool for a. fib?

Answer 11

echocardiography

can reveal valvular disease, chamber enlargement or intracardiac thrombi

Question 12

most common thromboembolism

Answer 12

nonvalvular afib

~50%

Question 13

is the risk of stoke increased or decreased with lone afib?

Answer 13

decreased. it is low ~1%

Question 14

4 consequences of a. fib

Answer 14

• thromboembolism
• diminished CO
• ischemic events
• exercise capacity diminution

Question 15

non-valvular causes of a. fib

Answer 15

• age > 65
• HTN
• rheumatic heart disease
• prior stroke of TIA
• DM
• CHF

Question 16

treatment goals of a. fib

Answer 16

rhythm and rate control

Question 17

goal of rhythm control

Answer 17

restore/ maintain sinus rhythm

Question 18

goal of rate control

Answer 18

maintain acceptable ventricualr rate in chronic A. fib

Question 19

which is better: rate or rhythm control

?

Answer 19

no survival advantage with either strategy

rhythm control have more adverse drug problems

Question 20

what is the primary choice for rhythm control

Answer 20

DC conversion. pharmacologic tx is less succesful and a secondary choice

Question 21

goal HR for rate control of a. fib

Answer 21

80-100 bpm

Question 22

common agents for acute rate control

Answer 22

beta blockers (metoprolol) and Ca2+ channel blockers (verapamil or ditiazem)

Question 23

when are antithrombotics not indicated?

Answer 23

if udner 60 yo or a lone A. fib

Question 24

what does NOAC stand for?

Answer 24

novel oral anticoagulant

Question 25

limitations for use of NOAC

Answer 25

cost
rapid onset and offset
no reversal agent

Question 26

what is the drop in stroke volume post a. fib

Answer 26

30%