AFIB

Question 1

Which 3 drugs are used for rate control?

Answer 1

B-blocker (meto), CCB (diltiazem, verapamil), Digoxin

Question 2

Which timeline defines paroxysmal Afib

Answer 2

terminates spontaneously or within 7 days

Question 3

What timeline defines persistent afib

Answer 3

7 days up to a year

Question 4

What timeline defines long-standing persistent

Answer 4

more than 12 months

Question 5

What timeline defines permanent afib

Answer 5

no longer pursue rhythm control

Question 6

What are 4 different means to do rhythm control?

Answer 6

Antiarryhytmic drugs, PerQ catheter ablation, Cardioeversion, or Surgery

Question 7

What is the target goal for rate control?

Answer 7

60-100

Question 8

If Afib patient HD unstable

Answer 8

Cardioevert

Question 9

If acute Afb patient HD stable, that more than 48 hours old AND considering cardioeversion, what anticoagulation? what about alternative

Answer 9

3 weeks before CE and 4 weeks after CE or doing an TTE!!

Question 10

CHADS2 score means?

Answer 10

C - CHF
H - HTN
A - Age > 75
D - DM
S - Stroke/TIA/Embolism 2 pt

Question 11

CHADS2-VASC

Answer 11

V - vascular disease (prior MI, PAD, or aortic plaque)
A - 65-74
S - sex = being a female

Question 12

CHADS2 score >= 2

Answer 12

Warfarin with INR goal of 2-3

Question 13

CHADS2 score = 1

Answer 13

Warfarin or ASA

Question 14

CHADS2 score = 0

Answer 14

ASA 100-300

Question 15

Bleeding risk score, HAS-BLED

Answer 15

H - HTN
A - Abnormal liver or nrenal function
S - stroke
B - bleeding
L - label INR
E - Elderly age > 65
D - drugs or alcohol

Question 16

name 2 types of novel oral anticogulants

Answer 16

1. Direct Thrombin Inhibitor - gatran (Dabigatrn, Ximelagatran)
2. Factor Xa inhibitor - xaban (Apixaban, rivaroxaban, Edoxaban, Betrixaban)

Question 17

Side effect of direct thrombin inhibitor

Answer 17

liver toxicity

Question 18

Benefit versus Disadvantage of NOAC

Answer 18

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

Question 19

Which 3 advantages have Xaban shows

Answer 19

1. lower risk of stroke/systemic clots
2. lower risk of hemorrhagic stroke
3. lower all-cause mortality

Question 20

When must use warfarin rather than NOAC?

Answer 20

1. Already on Warfarin with theurapeutic INR
2. Unlikely to comply with BID dosing schedule
3. severe CKD patients (creatinine clearance

Question 21

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

Answer 21

Correct

Question 22

Correct or Not: Avoid antiarrhythmic dtugs as the first line for AFib

Answer 22

Correct

Question 23

How to interpret HAS-BLED score?

Answer 23

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

Question 24

When to consider about rhythm control?

Answer 24

Patient with unpleasant symptoms or decreased exercise tolerance on rate control

Question 25

How to do rhythm control?

Answer 25

Direct-current CE or Pharm

Question 26

If acute Afb patient HD stable, that less than 48 hours old AND considering cardioeversion,

Answer 26

CE, then use CHADS2 score to calculate risk and start meds

Question 27

Which meds are for rhythm control in Afib? What are their ADRs?

Answer 27

1. Amiodarone - most effective but numerous side effects, ADR: pulm, hepatic, neuro, thyroid, corneal deposits, warfarin interaction
2. Propafenone: CI in pts with ischemic or structural heart disease, ADR: VT and HF
3. Sotalol: prolonged QT. ADR: torsafes, HF, exacerbation of COPD

Question 28

What are the causes of Afib?

Answer 28

1. Cardiac - surgery, cardiomyopathy, HF, HTN heart disease, ischemia, pericarditis, valvular dz
2. Non-cardiac: alcohol, chronic pulmonary disease, infection, pulmonary emboli, thyrotoxicosis