AFib Flashcards

1
Q

Types of AF

A

Paroxysmal
Persistent
Permanent

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2
Q

ECG findings

A

Absence of p waves
Fibrillatory waves in V1-3 or aVf
Irregularly irregular
170-180 bpm

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3
Q

Exam findings

A

No A wave in JVP
Auscultation - no S4

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4
Q

Causes

A

Pericarditis
PE or OSA
Ischemic heart disease or infarct
Rheumatic disease or other valvular pathology
Alcohol
Anemia
Thyrotoxicosis or toxins
Electrolytes
Sepsis

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5
Q

What are the signs of instability in a pt, and what is the management?

A

Altered mentation, hypotension, cardiac ischemia, angina, decompensated HF
Sedation + synchronised cardioversion with 200J

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6
Q

How to assess need for anticoagulation

A

CHAD65 score
> 65 y/o = use anticoagulation
< 65 y/o = any prior CHF, HTN, DM, Stroke or TIA = if yes, use anticoagulation
If none of these, check PAD or CAD = if yes, use antiplatelet like ASA or if already on ASA add clopidogrel
Take score, multiply by 2 = this is their yearly risk of stroke

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7
Q

CHADS2Vasc score points

A

CHF = 1
HTN = 1
Age >65 = 1, >75 = 2
DM = 2
Stroke/ TIA/ PE/ DVT = 2
Vas (MI, CAD, PAD) = 1

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8
Q

score to assess risk of bleeding from anticoagulation

A

HASBLED

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9
Q

When is warfarin 1st line?

A

valvular AF

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10
Q

Who needs rate control?

A

Symptomatic
Persistent AF should have HR <100
BB
Metoprolol IV 2.5-5mg now, repeat q15 mins x 2 until HR <100
HF - add digoxin as adjunct to BB
CAD - BB + CCB if further rate control needed
Sedentary - consider digoxin

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11
Q

Indications for rhythm control

A

Highly symptomatic - angina CP
Persistent AF impacting function
Multiple recurrences
If AF is causing cardiomyopathy

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12
Q

Method of cardioversion

A

If sx >24hrs, need to be anticoagulated x3 weeks before cardioverting
If <24hrs, can proceed immediately
If stable, use 100J

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13
Q

Risks of cardioversion

A

May not work
Sedation can cause apnea
If conversion works, might not cause relief of sx

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14
Q

Screening for AFib

A

check HR in all pts >65

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15
Q

How long to anticoagulant after cardioversion?

A

4 wks

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16
Q

How long to anticoagulant before cardioversion if high risk for a clot?

A

3 wks

17
Q

When to give rate control in AFib?

A

Older age, longstanding, asymptomatic

18
Q

When to give rhythm control in AFib?

A

Young, new diagnosis, symptomatic, no other comorbidities

19
Q

What tool to use for whether to give anticoagulant in AFib?

A

CCS CHADS-65 - CHF, HTN, Age 65+, DM, stroke/ TIA/ PE - if none of the above, do they have CAD? If yes - ASA

20
Q

When to use warfarin?

A

Valvular AFib