AFIB Flashcards
Which 3 drugs are used for rate control?
B-blocker (meto), CCB (diltiazem, verapamil), Digoxin
Which timeline defines paroxysmal Afib
terminates spontaneously or within 7 days
What timeline defines persistent afib
7 days up to a year
What timeline defines long-standing persistent
more than 12 months
What timeline defines permanent afib
no longer pursue rhythm control
What are 4 different means to do rhythm control?
Antiarryhytmic drugs, PerQ catheter ablation, Cardioeversion, or Surgery
What is the target goal for rate control?
60-100
If Afib patient HD unstable
Cardioevert
If acute Afb patient HD stable, that more than 48 hours old AND considering cardioeversion, what anticoagulation? what about alternative
3 weeks before CE and 4 weeks after CE or doing an TTE!!
CHADS2 score means?
C - CHF H - HTN A - Age > 75 D - DM S - Stroke/TIA/Embolism 2 pt
CHADS2-VASC
V - vascular disease (prior MI, PAD, or aortic plaque)
A - 65-74
S - sex = being a female
CHADS2 score >= 2
Warfarin with INR goal of 2-3
CHADS2 score = 1
Warfarin or ASA
CHADS2 score = 0
ASA 100-300
Bleeding risk score, HAS-BLED
H - HTN A - Abnormal liver or nrenal function S - stroke B - bleeding L - label INR E - Elderly age > 65 D - drugs or alcohol
name 2 types of novel oral anticogulants
- Direct Thrombin Inhibitor - gatran (Dabigatrn, Ximelagatran)
- Factor Xa inhibitor - xaban (Apixaban, rivaroxaban, Edoxaban, Betrixaban)
Side effect of direct thrombin inhibitor
liver toxicity
Benefit versus Disadvantage of NOAC
Benefit: convenience, small reduction in risk of ICH, less variation with dietary or drug interaction
Disadvantage: lack of adequate reversing agent, dose adjustment with CKD pts, hard to monitor blood level, higher cost, unidentified side effects
Which 3 advantages have Xaban shows
- lower risk of stroke/systemic clots
- lower risk of hemorrhagic stroke
- lower all-cause mortality
When must use warfarin rather than NOAC?
- Already on Warfarin with theurapeutic INR
- Unlikely to comply with BID dosing schedule
- severe CKD patients (creatinine clearance
Correct or Not: for pts with minimal sx or in those whom sinus rhythm cannot be easily achieved, rate control plus antithrombotic tx is the preferred tx strategy
Correct
Correct or Not: Avoid antiarrhythmic dtugs as the first line for AFib
Correct
How to interpret HAS-BLED score?
If CHADS2 score = 1 => ASA or Warfarin, but HAS-BLED score > 2, risk of bleeding may outweigh risk of stroke
if CHADS2 score >=2 => wafarin , but if HAS-BLEED score > CHADS2 score, risk of bleeding outweighs risk of stroke
When to consider about rhythm control?
Patient with unpleasant symptoms or decreased exercise tolerance on rate control
How to do rhythm control?
Direct-current CE or Pharm
If acute Afb patient HD stable, that less than 48 hours old AND considering cardioeversion,
CE, then use CHADS2 score to calculate risk and start meds
Which meds are for rhythm control in Afib? What are their ADRs?
- Amiodarone - most effective but numerous side effects, ADR: pulm, hepatic, neuro, thyroid, corneal deposits, warfarin interaction
- Propafenone: CI in pts with ischemic or structural heart disease, ADR: VT and HF
- Sotalol: prolonged QT. ADR: torsafes, HF, exacerbation of COPD
What are the causes of Afib?
- Cardiac - surgery, cardiomyopathy, HF, HTN heart disease, ischemia, pericarditis, valvular dz
- Non-cardiac: alcohol, chronic pulmonary disease, infection, pulmonary emboli, thyrotoxicosis
