AFIB Flashcards
predictors of Afib
advancing age, men, BMI >30, SBP >160, CHF, CAD, CRF, PR interval >160
Risk factors for AF
DM, hyperthyroidism, sleep apnea, alcohol, smokers
acute AF lasts?
<48 hours
Paroxysmal AF lasts?
<7 days and spontaneously returns to SNR without any interventions
Persistent AF lasts?
> 7 days, requires treatment to revert to NSR
Long-standing persistent AF lasts?
> 12 months
Permanent AF
no further attempts to convert back to NSR,
medications recommended for rate control?
Verapamil, Cardizem, BB
medications for rhythm control
amiodarone, dronedarone, propafenone, sotalol
A lenient resting heart rate for Afib should be what?
<110
A strict resting heart rate for Afib should be what?
<80
CHADS2 and CHA2DS2-VASc are used for what?
to predict risk for stroke
HAS-BLED is used for what?
to predict risk for bleeding
CHADS2 vs CHA2DS2-VASc
CHA2DS2-VASc adds female gender, vascular disease, age 65-72
recommended over CHADS2
CHADS2 stands for?
Congestive heart failure, hypertension, age>75, diabetes, stroke
CHA2DS2-VASc stands for
Congestive heart failure, hypertension, age >75, diabetes, stroke, vascular disease (MI, PAD, aortic atherosclerosis), Age 65-74, Sex
what do you give with a CHADS2 score of 0
no anticoagulation
what do you give with a CHADS2 score 1
ASA or oral anticoagulants
what do you give with a CHADS2 score of 2-6
Benefit>Harm
Does the AAFP recommend dual therapy with anticoagulants and antiplatelet therapy in patients with afib?
no
what situations may call for dual therapy with anticoagulants and antiplatelet?
immediately after a stent
HAS-BLED score range
0-9
HAS-BLED examines bleeding risk for which problems?
HTN, Renal dysfunction, Liver disease, Stroke, Bleeding Hx, Labile INR, Elderly, Medications, ETOH
HAS-BLED is validated only for which medication?
warfarin
INR >3 but < 4.5 interventions
decrease or hold dose then lower dose once INR is within normal limits
INR 4.5 to 10 interventions
hold next one or two doses then lower dose once INR is within normal limits-NO VITAMIN K
INR >10 interventions
administer vit K (2.5 to 5 mg po per dose)
Stroke risk factors
HTN, Diabetes, hyperlipidemia, Obesity, Sleep apnea, Smoking, Alcohol, lack of regular activity
virchows triad
3 categories of factors that are thought to contribute to thrombosis (Endothelial damage, Blood flow stasis, hypercoagulation)
what does the wells prediction rule help to diagnose?
predictor for diagnosing DVT or PE
wells prediction rule takes what into consideration for DVT?
active cancer, paralysis, recently bedridden, localized tenderness, leg swollen, calf swelling, pitting edema, collateral superficial veins (nonvaricose)
what kinds of DVTs are more dangerous than distal DVTS that are formed below the popliteal trifurcation in the veins of the calf?
Proximal DVTS that develop above the popliteal trifurcation in the popliteal and femoral veins of the thigh
AMUSE score
can help the provider decide if an ultrasound is needed
AMUSE score of <3
probs not a DVT, no ultrasound needed
AMUSE score of >4
probably a DVT, do ultrasound
AMUSE score takes what into consideration?
male sex, malignancy in last 6 months, had surgery within 1 month, absence of leg trauma, hormonal contraceptives, collateral leg vein distention, discrepancy of >3 cm in calf circum, elevated D-dimer
what is the treatment recommendation for PE or proximal DVT, what if they also have cancer?
anticoagulant therapy for 3 months, if they have cancer, heparin is needed
wells score for PE takes what into consideration?
PE most likely, surgery within last 4 weeks, previous DVT or PE, HR>100, Haemoptysis, active cancer
Pradaxa dose
150mg BID
Eliquis dosing
5mg BID
Xarelto dosing
20mg daily
Sacaysa dosing
60mg daily
