A-Fib Flashcards
this is the dominant pacemaker in the heart as it has the fastest rate of depolarization
SA node
what is the path of conduction in the heart
SA node –> AV node –> bundle of HIS (left and right bundle branches) –> Purkinje fibres
this wave on a normal ECG represents ventricular depolarization where the pressure inside the ventricles increase and the atrioventricular values shut
QRS
this wave on a normal ECG represents atrial depolarization where the valves between the atria and ventricles open
P
this wave on a normal ECG represents ventricle depolarization where the ventricle walls relax and recovers from the contraction
T
what are the two ways arrhythmias can form
- abnormal impulse formation
- abnormal impulse conduction (due to ischemic tissue)
with a normal sinus rhythm, where does the impulse originate from?
SA node
this represents a normal rate
60-100bpm
this represents a normal rhythm
normal ECG pattern
this occurs when the atria are contracting too fast, thus the ventricles are not being filled properly resulting in a decreased cardiac output. this occurs above the ventricles. it results in unsynchronized atrial contractions and irregular activation of the ventricles. it is usually characterized by an “irregularly irregular” pulse (irregular rate and irregular rhythm)
AFib / supra ventricular tachycarida
in AFib, erratic electrical impulses in the upper chambers of the heart (atria) cause those chambers to fibrillate or quiver. this results in an irregular and frequently rapid heart rate. the irregular, __________ pattern in the ECG show these impulses
sawtooth
true or false: AFib is the most common arrhythmia and the risk increases with age
true
true or false: routine screening is recommended for AFib
false
true or false: if a patient is over 65 and they present to someone in the healthcare system, screening for A-fib should be done
true
if there are any abnomarlaities in pulse palpitation, blood pressure monitoring, Apple Watch/smartphone readings, etc. the patient should be referred to have this done
12-lead EKG
this is a continuous AFib episode lasting longer than 30 seconds but terminating within 7 days of onset
paroxysmal AFib
this is a continuous AFib episode lasting longer than 7 days but less than 1 year
persistant AFib
this is continuous AFib > 1 year in duration in patients in whom rhythm control management is being pursued
“longstanding” persistant AFib
this is continuous AFib for which a therapeutic decision has been made not to pursue sinus rhythm restoration (just doing rhythm control and leave them with abnormal ECG pattern)
permanent AFib
AFib in the presence of any mechanical heart valve, or in the presence of moderate to severe mitral stenosis (Enlargement of the mitral valves)
valvular AFib
what are the established risk factors for AFib
- advancing age
- male
- HTN
- HF with reduced ejection fraction
- valvular heart disease
- hyperthyroidism
- obstructive sleep apnea
- obesity
- excessive alcohol intake
- congenital heart disease
what is the most common symptom of AFib
palpitations!!!!!
what are some other signs and symptoms of AFib
- lightheaded
- dyspnea
- chest pain
- fatigue
- weakness/reduced exercise tolerance
- syncope (fainting)
*increased HR usually leads to these symptoms due to decreased cardiac output
what are some complications of AFib
- angina
- heart failure
- cardiogenic stroke (atria are quivering and blood pools in the atria b/c not getting fully expelled; this can form a clot which can then be passed down into the ventricle which can go to the aorta and then the brain and get into a vessel that it cannot pass through causing a stroke)
true or false: AFib related stroke are more fatal than non-AFib related strokes
true
what are the two main management strategies for AFib
rate control and rhythm control
how should a patient who is hemodynamically unstable (e.g. AF with hypotension, ACS or pulmonary edema) be treated?
direct current cardioversion (DCCV) / aka paddles
is rate or rhythm control normally used in these patients?
< 65
rhythm control
is rate or rhythm control normally used in these patients?
anti-arrhythmic ADRs
rate control
is rate or rhythm control normally used in these patients?
> 65
rate control