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 (HFrEF)
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
What are class II and IV antiarrhythmics?
Class II: BB
Class IV: non-DHP CCB (diltiazem, verapamil)
What antiarrhythmics are used for rhythm control in:
- no/min. signs of structural heart disease
- CAD, HFpEF, significant valvular disease
- HFrEF
- no/min. signs of structural heart disease: class Ic (flecainide, propafenone), class III (dronedarone, sotalol)
- CAD, HFpEF, significant valvular disease: class III (amiodarone, dronedarone, sotalol)
- HFrEF: amiodarone
What monitoring should be done for amiodarone? (9)
- LFT
- TFT
- chest radiography
- pulmonary function tests
- ECG
- ophthalmologic examination
- skin toxicities
- neurologic toxicity
- N/V
What do different CHA2DS2VASc scores mean?
- 0 in men / 1 in women: no need anticoagulant
- 1 in men / 2 in women: consider anticoagulant
- 2 in men / 3 in women: anticoagulant
What does CHA2DS2VASc stand for?
- congestive HF
- HTN (>140/90 on ≥2 occasions or current antiHTN tx)
- age ≥75y (+2)
- DM (FBG >2 or on DM meds) (+1)
- prev stroke, TIA or thromboembolism (+2)
- vascular disease (prev MI, PAD)
- age 65-74y
- sex category (not counted in modified version)
Difference between antiplatelets & anticoagulants?
- antiplatelets block platelet aggregation (primary haemostasis) = prevent clots from forming
- anticoagulants block activation of fibrin polymerisation (secondary haemostasis) = prevent clots from growing (clots already formed)
Which group of pts have exceptionally high thromboembolic risk that oral anticoagulants should be started no matter what? What anticoagulant should these pts be started on?
- Presence of mechanical heart valves
- Moderate-severe mitral stenosis
Start warfarin
Are antiplatelets or anticoagulants used for preventing AF-related stroke?
Antigcoagulants
Which pts are at higher risk for stroke? (5)
- 65-74y
- HF & ≥35y
- HTN & ≥50y
- DM & ≥50y
- vascular disease & ≥55y
