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Acute Care I > Afib > Flashcards

Afib Flashcards

1
Q

Things to think about when a patient presents in afib

A
  1. Stable or unstable?
  2. How long have they had it/classification?
  3. What are contributing factors?
  4. Evaluation?
  5. Rate control vs rhythm control?
    Pharmacologic & nonpharmacologic approaches to rate/rhythm control?
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2
Q

Evidence of structural or electrical findings further predisposing a patient to AF include?

A

Atrial enlargement
Frequent atrial ectopy
Short bursts of atrial tachycardia
Atrial flutter
Other high AF risk scenarios

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3
Q

Various Stages of AF prior to permanent AF include?

A

Paroxysmal AF (3A)
Persistent AF (3B)
Long-standing persistent AF (3C)
Successful AF ablation (3D)

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4
Q

Patient stability, is the patient showing any signs of instability which include?

A

Acute HF
Hypotension
Worsening angina in pt with CAD

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5
Q

Whats the intervention for unstable AF?

A

Electrical cardioversion

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6
Q

Clinical manifestations of unstable AF?

A

Palpitations
CP
Fatigue
Lightheadedness
Dyspnea
Syncope
Asymptomatic
Embolic complication
Exacerbation of HF; most c/o fatigue, lightheadedness, dyspnea, syncope

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7
Q

3 objectives in management of AF include?

A

rate control
prevention of thromboembolism/stroke
Rhythm correction

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8
Q

What benefits does Rate Control bring?

A

Improves QOL
Reduces mortality
Decreases risk of cardiomyopathy
Shared decision making-rate v rhythm control
Comparable clinical outcomes in many patients compared to rhythm control

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9
Q

Goals of Rate control
AF w/ no other CVD?

A

Beta blocker, dilt, verapamil (I)
Amio (IIb)

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10
Q

Goals of Rate control
AF w/ HTN or HFpEF

A

Beta blocker, dilt, verapamil
Amio

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11
Q

Goals of Rate control
AF w/ LV dysfxn, HF

A

Beta blocker, digoxin
Amio

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12
Q

Goals of Rate control
AF w/ COPD

A

Beta blocker, dilt, verapamil

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13
Q

Acute Rate control in AF w/ RVR
Decompensated HF is present give what?

What can cause harm?

A

IV amio

Verapamil and dilt

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14
Q

Acute Rate control in AF w/ RVR
No decompensated HF is present give what?

A

Beta blocker, verapamil, dilt
Digoxin
Amio

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15
Q

Goals of Therapy With Rhythm Control
In patients with what condition and persistent AF, a trial of rhythm control should be recommended to evaluate whether AF is contributing to the problem?

A

Reduced LV fxn

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16
Q

Patient Factors that Favor Rate Control?

A

Older
Longer hx of AF
Fewer symptoms

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17
Q

Patient Factors that are variable for Rate vs Rhythm Control?

A

Age
Antecedent hx of AF
Symptom Burden

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18
Q

Patient Factors that favor Rhythm control?

A

Younger
Shorter hx of AF
More symptoms

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19
Q

Physical Examination Anatomy that favors rate control?

A

Easily controlled HR
Larger LA
Less LV dysfxn
Less AV regurgitation

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20
Q

Physical Examination Anatomy that are variable for rate vs rhythm control?

A

Rate control in AF
LA size
LV fxn in AF
AV regurgitation in AF

21
Q

Physical Examination Anatomy that favors rhythm control?

A

Difficult to control HR
Smaller LA
More LV dysfxn
More AV regurgitation

22
Q

Pharmacologic Cardioversion is usually chosen when?
“…” compared to DC CV is how effective?
“…” is most effective when?

A

first choice
less effective
in first 7 days

23
Q

Electrical Cardioversion is recommended in what scenarios?

A

In patients w/ hemodynamic instability attributable to AF
In patients w/ AF who are hemodynamically stable DC CV can be performed as initial rhythm control strategy or after unsuccessful pharm. CV

24
Q

Initial Energy delivery chosen for Electrical Cardioversion is what?

A

200J

25
Q

Can patients with pacers/ICDs be electrically cardioverted?

A

yes, but the device will need to be interrogated after CV

26
Q

What is the risk of thromboembolism events in patients not pre-treated w/ anticoagulation?

A

~1-7%

27
Q

Shock failure & immediate recurrence occur in what % of patients?

A

25%

28
Q

What can be given in conjunction w/ CV to lower CV threshold, thereby increasing success rate?

A

Antiarrhythmics

29
Q

What should the patient receive prior to CV to increase comfort?

A

conscious sedation or anesthesia

30
Q

In patients w/ AF duration of >/= 48 hrs what is recommended prior to elective cardioversion?

A

3 week duration of uninterrupted therapeutic anti-coagulation or imaging evaluation to exclude intracardiac thrombus

31
Q

In patients w/ AF undergoing cardioversion, therapeutic anticoagulation should be established before cardioversion and continued for how long afterwards w/o interruption to prevent thromboembolism?

A

4 weeks

32
Q

In patients w/ AF in whom cardioversion is deferred d/t LAA thrombus detected on pre-cardioversion imaging, therapeutic anticoagulation should be instituted for at least how long? after which imaging should be repeated prior to cardioversion.

A

3-6 weeks

33
Q

AF Pharmacologic CV
Normal LV fxn use what?

A

IV Amio
Ibutilide
Procainimide

34
Q

AF Pharmacologic CV
HFrEF (LVEF </=40%) use what?

A

IV Amio

35
Q

AF Pharmacologic CV
AF occurring outside the hospital in pts w/ normal LV fxn use what?

A

Flecainide
Propafenone

36
Q

AF Pharmacologic CV
Normal LV fx , no prior MI or significant structural heart disease use what?

A

Dofetilide
Dronedarone
Flecainide
Prropafenone
Amio
Sotalol

37
Q

AF Pharmacologic CV
Prior MI or significant structural heart disease, including HFrEF (LVEF </=40%) use what?

A

Amio
Dofetilide
Sotalol
Flecainide and Propafenone cause harm

38
Q

AF Pharmacologic CV
Prior MI or significant structural heart disease, including HFrEF (LVEF </=40%) w/ NYHA FC III or IV or recent decompensated HF use what?

A

Dronedarone if not
Dont use dronedarone if yes

39
Q

What is a clinical predictioin rule for estimating risk of stroke in non-rheumatic a-fib?

A

CHA2DS2-VASc score

40
Q

CHA2DS2-VASc score
Used to determine whether or not what is required?

A

antithrombotic threapy

41
Q

CHA2DS2-VASc score
A high score corresponds to what risk?

A

greater risk

42
Q

For patient w/ AF and an estimated annual thromboembolic risk of what? per year (eg CHA2DS2-VASc score of ___ in men and ___ in women), anticoagulation is recommended to prevent stroke and systemic thromboembolism?

A

> /=2%
/=2
/=3

43
Q

In patients w/ AF who do not have a hx of moderate to severe rheumatic mitral stenosis or mechanical heart valve, and who are candidates for anticoagulation what are recommended over what to reduce the risk of mortality, stroke, systemic embolism and ICH?

A

DOACs over warfarin

44
Q

What is the reversal agent for dabigitran?

A

idarucizumab

45
Q

Reversal agents for factor Xa inhibitors are?

A

andexanet alfa
4 factor-PCC

46
Q

Reversal agents for warfarin include?

A

Vitamin K
4 factor-PCC

47
Q

In patients w/ AF scheduled to Undergo an invasive procedure or surgery the timing of temporary discontinuation of DOACs: Low bleeding risk procedure; High bleeding risk procedure
Apixiban (CrCl > 25mL/min)?
Dabigatran (CrCl > 50mL/min)?
Dabigatran (CrCl 30-50mL/min)?
Edoxaban (CrCl > 15mL/min)?
Rivaroxaban (CrCl > 30mL/min)?
Warfarin?

A

1d; 2d
1d; 2d
2d; 4d
1d; 2d
1d; 2d
5 d for a target INR < 1.5 and 2-3 d for target INR < 2; 5d

48
Q

Elderly considerations with AF
AF increases w/?
~ what % of patients w/ AF are > 80y/o?
Consider what when treating?
Symptoms may be?
Risk of CVA is?
Sensitivity to pro-antiarrhythmics effects is?
Rate or Rhythm control is prefered? what is used?
Often more prone to what?

A

age
35%
co-morbidities
minimal &/or atypical
increased
increased
rate control; BB or CCB
orthostatic hypotension or bradyarrhythmias

Acute Care I (24 decks)

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