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Cardiology > A- Fib +CHF > Flashcards

A- Fib +CHF Flashcards

1
Q

What type of rhythm is A fib

A

irregularly irregular

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2
Q

facts about a fib

A

most common sustained arrhythmia

affects 1% of the population

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3
Q

Is A fib life threatning

A

NO

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4
Q

Common causes

A
  1. Htn
  2. Valvular dz
  3. CAD
  4. Cardiomyopathy
  5. PE
  6. Alcohol (“holiday heart syndrome”)
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5
Q

Clinical presentation of A fib

A

may be asymptomatic

palpitations, dizziness, lightheadedness, SOB, fatigue, CP

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6
Q

Risks involved with having A fib

A

Clot thrombus formation in the left atrial appendage
CHF
Tachycardic-induced cardiomyopathy
Syncope

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7
Q

A fib therapy

A

Rate- BB, CCB, Dig, anticoagulation

Rhythm- antiarrhythmics, cardioversion, surgery

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8
Q

What is the CHADS2 score?

A 
determines who we should anticoagulate
C- CHF=1
H- Htn= 1
A- Greater than 75= 1
D- Diabetes= 1
S- stroke, TIA= 2
CHADS score greater than 2= anticoagulation
CHADS score of 1=  clinical decision
CHADS score of 0= full strength asprin
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9
Q

What does the modified CHADS score include

A

V- Vascular
A- 65-74= 1
A- over 75=1
S= Female sex= 1

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10
Q

Coumadin reversal

A 
Vit K (24 hours)
FFP
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11
Q

Therapeutic INR for A fib

A

2-3

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12
Q

Therapeutic INR for mechanical valve

A

2.5-3.5

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13
Q

INR is for

A

Coumadin

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14
Q

PTT is for

A

Heparin

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15
Q

PTT for coagulated individuals

A

60-85 seconds

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16
Q

Reversal of Heparin

A

Protamine

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17
Q

Onset of action of heparin

A

Immediate (IV), 20-30 mins (SQ)

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18
Q

Onset of action for coumadin

A

24-72 hours with terapeutic effect in 5-7 days

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19
Q

Name some class 1 anti-arrhythmics

A

Tambocor (Flecanide)

Propafenone (Rhythmol)

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20
Q

Name some class 2 anti-arrhythmics

A

Beta blockers!!–> Betapace (sotalol)

21
Q

Name some class 3 anti-arrhythmics

A

Amniodarone
Dronadrone
Ibutilide (Corvert)– rapid
Dofetilide (Tikosyn)- CHF

22
Q

Serious side effects of amniodarone

A

Pulmonary fibrosis
Hyper/hypothyroidism
Liver toxicity

23
Q

Surgical options for a fib

A

AV node ablation with pacemaker
AV node modification
A-fib catheter ablation

24
Q

Symptoms of CHF

A 
Fluid accumulation and retention
SOB/Dyspnea on exertion
Orthopnea
PND
Edema
Ascites
Non-productive cough
25
Q

Left sided CHF symptoms

A

Pulomonary edema- rales+crackles
orthopnea
PND

26
Q

Right sided CHF symptoms

A 
peripheral edema
anascara (swelling under skin)
Ascites
JVD
Hepatomegaly
27
Q

New york heart association functional classification

A

Class 1- No limitations
Class 2- mild limitation, symptoms with ordinary activity
Class 3- moderte limitation, symptoms with less than ordinary activities
Class 4 - symptoms at rest

28
Q

ACC/AHA guidlines+stages

A

Stage A- High risk, without structural disease
Stage B- Structural disease
Stage C- Past or present symptoms of CHF
Stage D- refractory end stage CHF

29
Q

PE findings of CHF

A 
JVD
S3 or S4
Lateral deviation of apical impulse
Rales 
Peripheral edema
Tachycardia
Ascites
Labored breathing
30
Q

Tell me about frank-starling

A

Cardiac output increased or decreased in response to changed in the heart rate or stroke volume (volume of blood with each heart beat)

31
Q

Where will the frank-starling curve be in CHF

A

Shiffted downward, or to the right

32
Q

What is the problem with CHF

A

Decreased Cardiac output leading to blood back up

33
Q

Systolic CHF characteristics and causes

A

Loss of contractility+Reduced EF

Causes- MI, HTN, valvular dz

34
Q

Diastolic CHF characteristic and causes

A

stiffness + impaired relaxation or the ventricle
40% of all CHF
Ventricular hypertrophy, HTN, CAD

35
Q

CXR findings of CHF

A

increased interstitial markings, pleural effusions, Kerley B lines, cardiomegaly

36
Q

EKG findings of CHF

A

LVH, A fib, Old MI, ischemia

37
Q

Echo findings of CHF

A

decreased EF and hypertrophy

38
Q

Blood tests for CHF

A

BNP (above 400)

39
Q

Treatment of CHF

A

Lifestyle modifications- sodium and fluid restriction
Medications- Diuretics, ace, arb, nitrateds, BB, dig, inotropes (dopamine, dobutamine)
ICD
Heart transplant or LVAD

40
Q

What is the role of diuretics in treating CHF

A

Control volume

41
Q

What is the role of ACE and ARB

A

Slow disease progression,
Works on the renin-angiotensin-aldosterone axis
Vasodialates + decrease afterload

42
Q

What is the role of Digoxin in CHF

A

treat residual symptoms, makes heart squeeze harder by increaseing intracellular calcium and slows AV conduction
USED for SYSTOLIC

43
Q

What is the role of beta blockers in CHF

A

Slows disease progression when given with ACE

decreases contractility

44
Q

What is the role of hydralazine and nitrated in CHF

A

Vasodialate

African americans do better with this combo

45
Q

What is the role of inotropes (dopamine, doubotomine) in CHF

A

Increase cardiac contractility and cardiac output
Used in Severe decomp CHF
INCREASES MORTALITY
Short term solution

46
Q

Who gets and ICD with CHF

A

Stage B+C

47
Q

when is someone too old for a heart transplant

A

65

48
Q

indications for heart transplant

A

end stage disease with no other option

49
Q

LVAD

A

takes over or assists with the pumping of the LV

Cardiology (8 decks)

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