A Fib And A Flutter

Question 1

Who is afib most common in

Answer 1

> 60
White males

Question 2

A fib risk factors

Answer 2

HTN, diabetes, Cardiac disease, obesity, OSA

Question 3

S/s of a fib

Answer 3

Exercise intolerance, dizzy, syncope, palpitations

Question 4

How to differ paroxysmal vs persistent A fib?

Answer 4

Paroxysmal: starts and stops spontaneously within a week
Persistent: exceeds seven days

Question 5

Rate control treatment for A fib

Answer 5

Acute: BB or CBB IV or PO, Digoxin for HF, HR goal <100
Chronic: HR goal <80, CBB or BB, Digoxin
May need ablation or cardioversion if persistent

Question 6

Anticoagulation treatment for a fib

Answer 6

NOAC or Coumadin (if valve replacement)
CHA2DS2 score: 0 no treatment, 1 potential treatment, 2 or more treatment
(CHF, HTN, >75yo(2), DM, Stroke(2), Vascular disease, 65-74, Sex)

Question 7

What is the treatment for Anticoagulation prior to cardioversion

Answer 7

AC x 3 weeks before and 4 weeks after
Anticoag and TEE

Question 8

Coumadin reversal

Answer 8

FFP and Vitamin K

Question 9

Eliquis and Xarelto reversal

Answer 9

Andexxa

Question 10

Pradaxa reversal

Answer 10

Praxbind

Question 11

What are the atrial rates in a flutter

Answer 11

200-300 BM

Question 12

Describe the circuit in right atrial flutter vs left atrial flutter

Answer 12

Right: Counterclockwise revolving circuit in the inferior vena cava and tricuspid valve. Produces negative sawtooth pattern and positive p waves
Left: circuit in the left atrium caused by reentry. Not a typical a flutter morphology

Question 13

A flutter treatment

Answer 13

Hemodynamic unstable: Cardiovert
AV node blocking agents
Anticoagulation
Antiarrythmics: Sotalol, Amiodarone, or dysopyramide if unsuccessful cardioversion
Ablation if unsuccessful