AFIB

Question 0

Chronic AFIB can lead to?

Answer 0

1. Rapid ventricular rate leading to myocardial ischemia or exacerbation of heart failure
2. Thrombus formation in the noncontractile atria leading to embolization

Question 1

Rates of atrial depolarization in a afib?

Answer 1

300 400 bpm

Question 2

Two most common causes of atrial fibrillation?

Answer 2

Hypertension and coronary atherosclerosis

Question 3

Medications that can cause atrial fibrillation?

Answer 3

Theophylline, caffeine, digitalis

Question 4

Congenital heart diseases that can lead to atrial fibrillation?

Answer 4

Atrial septal defect, Ebstein anomaly

Question 5

Causes of atrial fibrillation?

Answer 5

I SMART CHAP
Inflammatory disease (Pericarditis, myocarditis)
Surgery
Medications
Atherosclerotic coronary artery disease
Rheumatic heart disease
Thyrotoxicosis
Congenital heart disease
Hypertensive heart disease
Alcohol consumption
Pulmonary disease

Question 6

In a patient in acute atrial fibrillation that is hemodynamically unstable(?), Tx?

Answer 6

Hemodynamically unstable = hypertensive, angina pectoris, or pulmonary edema

Use direct current cardioversion

Question 7

If patient in acute Atrial fibrillation is hemodynamically stable, treatment?

Answer 7

Intravenous beta blockers, calcium channel blockers, or digoxin to control ventricular rate

Question 8

If atrial fibrillation exceeds 48 hours, increased risk of what?

Answer 8

Intra-atrial thrombus formation

Question 9

After 48 hours of atrial fibrillation what should be given prior to and after cardioversion? Alternatively? Can also treat with what drugs?

Answer 9

3 to 4 weeks of warfarin therapy. Alternatively, low-risk patients can undergo transesophageal echo to exclude the presence of atrial thrombus. Can try to treat with procainamide, sotalol, and amiodarone

Question 10

Two factors that decrease the chance of successful cardioversion to sinus rhythm after AFIB?

Answer 10

Left atrial dilation (greater than 4.5 cm) and duration of atrial fibrillation

Question 11

Treatment of chronic atrial fibrillation to reduce the risk of stroke? (By how much?)

Answer 11

Warfarin decreases risk of stroke by two-thirds

Question 12

Goal INR with warfarin treatment and chronic atrial fibrillation (If atrial fibrillation is not caused by valvular disease)?

Answer 12

2 to 3

Question 13

Lonely AFIB? Risk of stroke? Treatment?

Answer 13

Atrial fibrillation that develops in patients younger than 60 years without evidence of structural heart disease, hypertension, or other factors for stroke. Risk of stroke is very low. Anticoagulation with warfarin is not used. Use low-dose aspirin

Question 14

If, with warfarin anticoagulation, INR is greater than 6, give?

Answer 14

Vitamin K without bleeding. Vitamin K and fresh frozen plasma if bleeding

Question 15

AFIB can be life-threatening with this preexcitation syndrome

Answer 15

Wolff-Parkinson-White syndrome

Question 16

Mechanism of Wolff-Parkinson-White syndrome?

Answer 16

Accessory pathway provides an alternate route for electrical communication between the atria and ventricles leading to early ventricular depolarization that begins before AV node conduction

Question 17

ECG sign for Wolff-Parkinson-White syndrome? Effect on QRS complex and PR interval?

Answer 17

Delta wave. Widens the QRS complex and shortens the PR interval

Question 18

Avoid these drugs and Wolff-Parkinson-White patients with atrial fibrillation (why?)

Answer 18

Digoxin, verapamil And other AV node blocking agents. These Increased ventricular rate.

Question 19

Tx for Wolff-Parkinson-White syndrome?

Answer 19

Procainamide or ibutilide to slow conduction and convert the rhythm to sinus

Question 20

In patients with atrial fibrillation with a heart rate of 140 bpm and blood pressure of 75/48, tx?

Answer 20

DC cardioversion