A- Fib +CHF Flashcards
What type of rhythm is A fib
irregularly irregular
facts about a fib
most common sustained arrhythmia
affects 1% of the population
Is A fib life threatning
NO
Common causes
- Htn
- Valvular dz
- CAD
- Cardiomyopathy
- PE
- Alcohol (“holiday heart syndrome”)
Clinical presentation of A fib
may be asymptomatic
palpitations, dizziness, lightheadedness, SOB, fatigue, CP
Risks involved with having A fib
Clot thrombus formation in the left atrial appendage
CHF
Tachycardic-induced cardiomyopathy
Syncope
A fib therapy
Rate- BB, CCB, Dig, anticoagulation
Rhythm- antiarrhythmics, cardioversion, surgery
What is the CHADS2 score?
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
What does the modified CHADS score include
V- Vascular
A- 65-74= 1
A- over 75=1
S= Female sex= 1
Coumadin reversal
Vit K (24 hours) FFP
Therapeutic INR for A fib
2-3
Therapeutic INR for mechanical valve
2.5-3.5
INR is for
Coumadin
PTT is for
Heparin
PTT for coagulated individuals
60-85 seconds
Reversal of Heparin
Protamine
Onset of action of heparin
Immediate (IV), 20-30 mins (SQ)
Onset of action for coumadin
24-72 hours with terapeutic effect in 5-7 days
Name some class 1 anti-arrhythmics
Tambocor (Flecanide)
Propafenone (Rhythmol)
Name some class 2 anti-arrhythmics
Beta blockers!!–> Betapace (sotalol)
Name some class 3 anti-arrhythmics
Amniodarone
Dronadrone
Ibutilide (Corvert)– rapid
Dofetilide (Tikosyn)- CHF
Serious side effects of amniodarone
Pulmonary fibrosis
Hyper/hypothyroidism
Liver toxicity
Surgical options for a fib
AV node ablation with pacemaker
AV node modification
A-fib catheter ablation
Symptoms of CHF
Fluid accumulation and retention SOB/Dyspnea on exertion Orthopnea PND Edema Ascites Non-productive cough
Left sided CHF symptoms
Pulomonary edema- rales+crackles
orthopnea
PND
Right sided CHF symptoms
peripheral edema anascara (swelling under skin) Ascites JVD Hepatomegaly
New york heart association functional classification
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
ACC/AHA guidlines+stages
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
PE findings of CHF
JVD S3 or S4 Lateral deviation of apical impulse Rales Peripheral edema Tachycardia Ascites Labored breathing
Tell me about frank-starling
Cardiac output increased or decreased in response to changed in the heart rate or stroke volume (volume of blood with each heart beat)
Where will the frank-starling curve be in CHF
Shiffted downward, or to the right
What is the problem with CHF
Decreased Cardiac output leading to blood back up
Systolic CHF characteristics and causes
Loss of contractility+Reduced EF
Causes- MI, HTN, valvular dz
Diastolic CHF characteristic and causes
stiffness + impaired relaxation or the ventricle
40% of all CHF
Ventricular hypertrophy, HTN, CAD
CXR findings of CHF
increased interstitial markings, pleural effusions, Kerley B lines, cardiomegaly
EKG findings of CHF
LVH, A fib, Old MI, ischemia
Echo findings of CHF
decreased EF and hypertrophy
Blood tests for CHF
BNP (above 400)
Treatment of CHF
Lifestyle modifications- sodium and fluid restriction
Medications- Diuretics, ace, arb, nitrateds, BB, dig, inotropes (dopamine, dobutamine)
ICD
Heart transplant or LVAD
What is the role of diuretics in treating CHF
Control volume
What is the role of ACE and ARB
Slow disease progression,
Works on the renin-angiotensin-aldosterone axis
Vasodialates + decrease afterload
What is the role of Digoxin in CHF
treat residual symptoms, makes heart squeeze harder by increaseing intracellular calcium and slows AV conduction
USED for SYSTOLIC
What is the role of beta blockers in CHF
Slows disease progression when given with ACE
decreases contractility
What is the role of hydralazine and nitrated in CHF
Vasodialate
African americans do better with this combo
What is the role of inotropes (dopamine, doubotomine) in CHF
Increase cardiac contractility and cardiac output
Used in Severe decomp CHF
INCREASES MORTALITY
Short term solution
Who gets and ICD with CHF
Stage B+C
when is someone too old for a heart transplant
65
indications for heart transplant
end stage disease with no other option
LVAD
takes over or assists with the pumping of the LV
