Afib Flashcards
Afib
Characterrization
> **Disorganized, papid, and irregular Atrial activation **
- Loss of atrial contraction
- Irregular venticular rate
- *Determined by AV nodal conduction
- Can exceed 200 bmp *
Major Pumplic Health
> Afib is most common sustained arrhythmia
Major public health problem
Prevalence of
Afib
**Increase w age **
- 95% with Afib >60yrs
- Age 80 around 10%
- Men > Women
- White > Black
Risk Factors
- HTN
- Diabetes
**Cardiac Disease **»_space;» R/O - Obesety
- Sleep Apnea
Afib
Consequences
> Due to RVR, loss of atrial contibution, Thrombus formation :
- Associated risk of Heart Failre , especialy
- - Vice Versa: CHF can cause Afib
-Associated Risk for stroke by 5 folds , cause 25% CVA
-Increase Risk of dementia
Precipitating Factors
> Hyperthyroidism
Alcohol Intoxication
Acute illness : PNA , AMI or PE
Cardiac Surgery :** pericarditis inflammatory**
signs and symptoms
> Exercese intolerance
Easily fatique
Dizzy occasional
Syncope (due to pause
Palpitations, chest fluttering (w or w/o )
Paroxysmal VS Persistent
**Paroxysmal : **
> Start spontaneuously and stop within **seven days of onset **
Cathertr Ablation
Paroxysmal VS Persistent
**Persistent **
> Longer duration **exceeding 7 days **
Cardioversion
Afib Treatment
> Guided by pt symptoms, hemodynamics, duration, risks of stroke
Cardioversion : unstable pt –> Hypotension PE CVA
Stable : Rate control
Antigagulation : CHA2DS2 -VASc score
** Before Cardioversio: afib cause unclear or longer than 48H hours —> Noach —> Anticoagulation»_space;> Heparing or Full dose Lovenox
CHA2DS2 -VASc score
**Based on Point System **
> 0: no antigoagulation
> 1: debatable: NOAC or ASA or nothging
> 2 or > yes for NOAC
Cardiovresion
Afib of unknown cause and longer than 48 Hours
- AC (anticoagulation continues ) x 3 wks and x 4 wks following cardioversion
- TEE determing clot in left atrium apandige
> follwing 4 weeks antioguagulation for aloud recovering atrium mechanical function
Tx Plan
Acute VS Chronic
o **Acute **
Ventricular rate <100 /min
Guided by clinical situation (avoid non-compliance)
**Chronic**
Alleviate and prevent deterioration
** Resting HR goal <80 bmp **
**On Light Exertion: < 100 bmp **
Combination BBB, CCB, Digoxin (CHF, selectively if rate control not achieved )
Atrial Flutter
> Due to circuitry revolving around Tricuspid Annulus - Right side
Passes b/w IVC & Tricuspid Valve annulus
Cicutit revoves —> Counterlokwise directions
Negative sawthooth II, III and aVF
Positive P waves in Lead V 1
2:1 AV block
Sotalol, Amiodarone, or Dysoyramide
