A Fib

Question 1

What is the best test for detecting atrial thrombus?

Answer 1

TEE > TTE (Ultrasound)

Question 2

Pathophysiology of A-FIb

Answer 2

Elevated atrial pressure causes a STRETCH. The cause can be structural, electrical, or contractile. Electrical remodeling is due to increased atrial rates. Structural remodeling is due to fibrosis, extracellular and myocyte changes.

Question 3

Etiologies of A Fib

Answer 3

Age/Alcohol
Thyroid
Round the Heart (HTN, Cardiomyopathy, Pericarditis)
Ischemia
Acute Stresss (inflammatory state, hypotension/Shock/hypoxia, electrolyte abnormalities, infarction)
Lung (COPD, pneumonia, embolus)
Fluid Overload (holiday heart)
Infection
Bad Valve

Question 4

What are the clinical issues to address in A Fib?

Answer 4

Rate Control vs. Rhythm Control

Anti-coagulation

Question 5

What is the best treatment for a patient with no heart disease in A Fib?

Answer 5

Flecanide

Question 6

What is the MOA of flecanide?

Answer 6

Class IC Anti-arrhythmic

Question 7

What is the best drug for rhythm control in A Fib?

Answer 7

Amiodarone, but it is CONTRAINDICATED in patients > 70

Question 8

CHADS2

Answer 8

CHF, HTN, AGE > 75, DM, STROKE/TIA x 2

greater or = to 1 is 3%

Question 9

CHA2DS2VASc

Answer 9

Vascular Dx, Age 65-74 is 1, >75 is 2
Female is 1
3 is 3.2%

Question 10

What is used for RATE CONTROL in A Fib?

Answer 10

Diltiazem, a CCB

Question 11

What is the treatment for recurrent symptomatic episodes of A FIb?

Answer 11

Ablation Therapy–> minimally invasive therapy where areas abnormally firing in atria are destroyed

Question 12

What labs to check in A Fib?

Answer 12

Hyperthyroidism can cause A Fib so check TSH

Question 13

What is the goal of anticoagulation in A Fib?

Answer 13

Prevention of stroke