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STEP 2 Cardio + Renal > AF, Aflutter 09-x (1) > Flashcards

AF, Aflutter 09-x (1) Flashcards

1
Q

AF ectopic location?

A

pulmonary veins

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2
Q

AF ECG? 3

A

Irregularly irregular rhythm with varying R-R intervals
No clearly discernible P waves
Narrow-complex tachycardia

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3
Q

AF symptoms?

A

Palpitations
Weakness/fatigue
Dizziness
Presyncope
Dyspnea
Chest pain/tightness

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4
Q

AF ventricular response?

A

HR > 150 k/min.

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5
Q

AF. Hemodynamically unstable?

A

Syncope
Symptomatic hypotension
Acute HF, pulmonary edema
Ongoing myocardial ischemia
Cardiogenic shock

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6
Q

paroxysmal AF?

A

AF that terminates sponateously OR with intervention within 7 days of onset.

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7
Q

AF that terminates sponateously OR with intervention within 7 days of onset?

A

paroxysmal AF?

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8
Q

Persistent AF?

A

AF that is continuously sustained beyond 7 days, including episodes terminated by cardioversion (drug or electrical cardioversion) after >= 7 days.

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9
Q

AF that is continuously sustained beyond 7 days, including episodes terminated by cardioversion (drug or electrical cardioversion) after >= 7 days.

A

Persistent AF

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10
Q

Long-standing persistent AF?

A

Continuous AF > 12 months when decided to adopt a rhythm control stategy

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11
Q

Continuous AF > 12 months when decided to adopt a rhythm control stategy

A

Long-standing persistent AF

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12
Q

Permanent AF?

A

AF that is accepted by the patient and physician, an no further attempts to restore/maintain sinus rhythm will be undertaken.

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13
Q

AF that is accepted by the patient and physician, an no further attempts to restore/maintain sinus rhythm will be undertaken.

therm should now be used in the context of a rhythm control strategy with antiarrhytmic drug therapy or AF ablation.

A

Permanent AF

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14
Q

AF DIAGNOSTIC CRITERIA? 2

A

12-lead ECG recording
OR
single-lead ECG tracing of >=30 s

If fulfills this criteria –> it is CLINICAL AF.

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15
Q

Primary diagnostic workup for AF?

A

Medical history: AF related symptoms, AF patterns, concomitant conditions, CHA2DS2VAS2 score; 12 lead ECG, Thyroid and kidney function, electrolytes, full blood count, TTE.

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16
Q

AF management abreviation?

A

ABC pathway

A Anticoagulation/Avoid stroke;

B Better symptom management;

C Cardiovascular and Comorbidity optimization

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17
Q

CHA2DS2-VASc. C?

A

Congestive heart failure

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18
Q

CHA2DS2-VASc. H?

A

Hypertension
Also patients on antihypertensive therapy

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19
Q

CHA2DS2-VASc. A2?

A

Age >= 75

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20
Q

CHA2DS2-VASc. D?

A

DM

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21
Q

CHA2DS2-VASc. S2?

A

Stroke/TIA/Thromboembolism

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22
Q

CHA2DS2-VASc. V?

A

Vascular disease - prior. MI, PAD, aortic plaque, angiographically significant CAD

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23
Q

CHA2DS2-VASc. A?

A

age 65-74 y/o

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24
Q

CHA2DS2-VASc. Sc?

A

Sex category - i.e. FEMALE

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25
Q

AF + NO prosthetic valve or mitral stenosis. What is the 1 step?

A

Identify low risk patients, i.e. Male 0 points, female 1 point.

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25
Q

AF + NO prosthetic valve or mitral stenosis.
If patients is low risk, what anticoagulation?

A

NO ANTICOAGULATION

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26
Q

AF + NO prosthetic valve or mitral stenosis.
Patient IS NOT LOW RISK.

If patient is intermediate risk? what score and what treatment?

A

Male >= 1
Female >= 2

OAC should be CONSIDERED (individually)

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27
Q

AF + NO prosthetic valve or mitral stenosis.

Intermediate risk. Which 2 points carries highest tromboembolism risk?

A

Age 65 to 74 years (pats stipriausias faktorius!!!!) and the presence of heart failure –> GIVE OAC

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28
Q

AF + NO prosthetic valve or mitral stenosis.

Intermediate risk. When OAC not needed?

A

low burden of AF (eg, AF that is well documented as limited to an isolated episode that may have been due to a reversible cause such as recent surgery, heavy alcohol ingestion, or sleep deprivation

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29
Q

What is recommended for anticoagulation in general?

A

NOAC > warfarin

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30
Q

AF + NO prosthetic valve or mitral stenosis.
Patient IS HIGH risk. what score and what treatment?

A

Male >= 2
Female >=3

OAC RECOMMENDED

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31
Q

AF + YES prosthetic valve or mitral stenosis.

treatment?

A

VKA (warfarin)
INR range depends on type of valve lesion or prosthesis

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32
Q

When initiating antithrombotic therapy, what need to evaluate?

A

Bleeding risk according to HAS BLED scale

33
Q

HAS BLED. H?

A

Hypertension

34
Q

HAS BLED. A?

A

Abnormal RENAL and/or HEPATIC function
(dialysis, transplant, creat. >200, cirrhosis, bilirubin > x2 upper limit, AST/ALT/ALP > 3 x upper limit

each gets 1 point (renal/hepatic)

35
Q

HAS BLED. S?

A

Stroke

previous ischemic or hemorrhagic

36
Q

HAS BLED. B?

A

Bleeding history or predisposition

Prior major bledding or anemia or severe thrombocytopenia

37
Q

HAS BLED. L?

A

Labile INR (TTR < 60 proc. in patient receiving VKA)

Only relevant if patient receiving a VKA.

38
Q

HAS BLED. E?

A

Elderly > 65 y/o or extreme frailty

39
Q

HAS BLED. D?

A

Drugs or excessive alcohol drinking

Alcohol excess or abuse refers to a high intake (e.g. >14 units per week),

40
Q

Absolute contraindications for OAC.

Blood diseases?

A

severe thrombocytopenia <50 platelets/lL or known coagulation defect associated with bleeding, severe anemia under investigation

40
Q

Has bled - what score high risk?

A

High risk of bleeding (HAS-BLED score >=3)

41
Q

High bleeding risk in HAS BLED. What to do with OAC?

A

high bleeding risk score should NOT lead to withholding OAC, as the net clinical benefit of OAC is even greater amongst such patients

42
Q

Absolute contraindications for OAC.

bleeding?

A

active bleeding, concern for ongoing bleeding, recent surgery, recent high-risk bleeding event such as intracranial haemorrhage (ICH)

43
Q

Absolute contraindications for OAC.

vessel? 2

A

Aortic dissection

Malignant hypertension

44
Q

Antiplatelet therapy for AF?

A

NOT recommended for stroke prevention in AF.

45
Q

AF rivaroxaban standard dose?

A

20 mg 1k/d.

46
Q

AF rivaroxaban reduced dose?

A

15 mg 1/kd.

47
Q

When do we reduce rivaroxaban dose? 2 reasons

A

CrCl < 50 ml/min

Should be considered lower dose when Has Bled high risk and patient takes mono or dual antiplatelet therapy

48
Q

AF apixaban standard dose?

A

5 mg 2 k/d.

49
Q

AF apixaban lower dose?

A

2,5 mg 2k/d.

50
Q

when do we reduce apixaban dose?

A

2 of 3 criteria
Age >= 80 y/o
Weight =< 60 kg
Creatinine > 133

51
Q

AF and antiplatelet therapy, need warfarin. Dose?

A

Dosing shoud be carefully regulated with target INR of 2-2,5 and TTR > 70 proc.

52
Q

RATE CONTROL.

No comorbidities or hypertension or HFpEF > 40 proc.?

A

First line:
BAB or NCCB

53
Q

RATE CONTROL.

No comorbidities or hypertension or HFpEF > 40 proc.. No response to first line?

A

DIGOXIN

and/or BAB/ and or NCCB

54
Q

RATE CONTROL.

HFrEF <40%?
first line

A

First line is BAB

55
Q

RATE CONTROL.

HFrEF <40%?
no response to first line?

A

BAB and/or DIGOXIN

and/or amiodarone

56
Q

RATE CONTROL.

Severe COPD or Asthma. First line?

A

first line NDCC

57
Q

RATE CONTROL.

Severe COPD or Asthma. no response to first line?

A

NDCC and/or Digoxin

58
Q

metoprolol, bisoprolol are cardioselective, therefore use in asthma

DO not use propranolol

59
Q

target HR?

60
Q

Rhythm control. First thing we evaluate?

A

HD stability

61
Q

Rhythm control.
Unstable. What to do?

A

Emergency electrical cardioversion
THEN
Check OAC status and ASAP decide on OAC.
If CHADSVAS intermediate or high risk –> long term OAC.

62
Q

Rhythm control.
Stable. What to evaluate?

63
Q

Rhythm control.
Stable and on OAC. Whats next?

A

Cardioversion as desired: immediate OR delayed for possible spontaneous atsistatymui. –> then CHADSVAS and decide on OAC

64
Q

Rhythm control.
Stable and NOT OAC. Whats next?

A

Start ASAP
NOAC or LMWH or UHF

65
Q

Rhythm control.
Stable and NOT OAC –> you started OAC. what to check next?

A

Check current AF episode duration

66
Q

Rhythm control.
Stable and NOT OAC –> you started OAC.
If duration from onset < 48h?

A

Early cardioversion: pharm or electrical.

OR

Wait for delayed cardioversion = wait spontaneous atsistatymo arba pharm/electr. within 48h.

67
Q

Rhythm control.
Stable and NOT OAC –> you started OAC.
If duration from onset < 48h and choose EARLY. What are the ideal cadidates? 2

A

AF onset <12 val and no previous TE

AF onset 12-48h and chadsvas 1 in males, 2 in females.

68
Q

Rhythm control.
Stable and NOT OAC –> you started OAC.
If duration from onset < 48h and choose DELAYED. What are the ideal camdidates? 2

A

AF onset <12 val and no previous TE

AF onset =< 24h and chadsvas 1 in males, 2 in females.

69
Q

After early or delayed also proceed to CHADSVAS and decide long term OAC

70
Q

Rhythm control.
Stable and NOT OAC –> you started OAC.
If duration from onset > 48h. what can be cardioversion?

A

ELECTIVE cardioversion:
both pharm and electrical

71
Q

Rhythm control.
Stable and NOT OAC –> you started OAC.
If duration from onset > 48h. what are 2 requirement to perform?

A

Within < 3 weeks of therapeutic OAC + NO LA thrombus on TTE.

After > 3 weeks of therapeutic OAC.

72
Q

Rhythm control.
Stable and NOT OAC –> you started OAC.
If duration from onset > 48h. 3 ideal candidates?

A

AF >=48h or unknown duration

AF 12-48h + Chadsvas high risk (2/3 score)

AF with previous TE or mitral stenosis or prostetic valve.

73
Q

Rhythm control - when indicated? 3 reasons

A

Unable to achieve adequate heart rate control (resting should be <110 bpm)

Recurrent symptomatic episodes – we perform cardioversion to alleviate AF symptoms

Heart failure symptoms

74
Q

New AF. what important to evaluate?

A

All patients with new-onset AF should be evaluated for occult hyperthyroidism

75
Q

Precipitants of atrial dilation and/or conduction remodeling?

A

HTN – most common predisposing factor

MV dysfunction
Left ventricle failure, CAD, CAD-related factors (CD, smoking)
OSA, obesity
Chronic hypoxic lung disease (eg. COPD, pneumonia)
Atrial septal defect

76
Q

Triggers of increased automaticity

A

Hyperthyroidism
Excessive alcohol use

Increased sympathetic tone
- Acute illness (sepsis, PE, MI)
- Cardiac surgery

Sympathomimetic drugs (eg cocaine, amphetamines)

77
Q

Aflut. location?

A

reentrant circuit around the tricuspid annulus, which is called cavotricuspid isthmus.

78
Q

Aflut. ECG?

A

Findings
a. Rapid rate
b. “Sawtooth” flutter waves

STEP 2 Cardio + Renal (55 decks)

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