AF Flashcards
Possible sx of AF?
- palpitation
- chest pain
- dyspnea
- fatigue
- lightheadedness
What are the two types of pharm therapy for AF?
- rate control
- rhythm control
What’s the target HR for rate control?
< 100-110bpm
without HF
Treatment options for rate control?
BB, non-DHP CCB, digoxin, amiodarone
When is BB indicated for rate control?
- 1st line
- preferred in pts with MI hx
- for HFrEF: Bisoprolol, carvedilol, metoprolol
- for HTN: labetalol, carvedilol
When is non-DHP CCB indicated for rate control? When to avoid?
- pts CI to BB
- preferred over BB in pts with asthma or COPD
- avoid if concomitant LV systolic dysfunction
When is digoxin indicated for rate control?
- pts CI to BB
- add-on to BB or non-DHP CCB
- add-on for pts with HFrEF
- for pts with uncontrolled HR, decompensated HF
When is amiodarone indicated for rate control?
- last line
What is considered tachyarrhythmias and bradyarrhythmias in terms of HR?
- tachy: >100bpm
- Brady: <60bpm
What drugs cause QTc-prolongation?
- antiarrhythmics (amiodarone, sotalol)
- antimicrobials: FQ, macrolides, azoles
- antidepressants: SSRI, TCA, SNRI
- antipyschotics
- triptans
What is the approach to managing AF?
ABC
- Avoid stroke (anticoagulation)
- Better sx control (rate, rhythm control)
- CV risk factors & concomitant disease (manage)
What are the lines of treatment for rate control?
- BB or non-DHP CCB
- use BB if HFrEF
- use non-DHP CCB if BB CI - BB or non-DHP CCB (if not tried yet)
- add digoxin to BB if HFrEF
- replace or add digoxin to non-DHP CCB if CI BB - amiodarone
When to consider rhythm control?
- sx despite rate being well-controlled
- pt would benefit from being in sinus rhythm (e.g. young age)
- high likelihood to maintain sinus rhythm (short history, precipitated by temporary event)
What classes of antiarrhythmic drugs are used for rhythm and rate control?
- rhythm: class I & III
- rate: class II & IV
What are class I and III antiarrhythmics?
Class 1(c): flecainide, propafenone
Class III: amiodarone, dronedarone, sotalol
