All about A-fib Flashcards
What test is used to verify and diagnose AF?
electrocardiogram (ECG)
AF is a _____ tachycardia.
supraventricular
______, although now uncommon in developed countries, is associated with a much higher incidence of AF.
Rheumatic heart disease
AF that has lasted for more than 12 months is called?
Long-standing persistent AF
How is AF prevented?
we don’t know
What is Permanent AF?
persistent atrial fibrillation; no longer pursue a rhythm control strategy
How often to AF pts need routine follow up?
every 12 mos if controlled
AF can have adverse consequences related to a reduction in cardiac output and to ______.
atrial and atrial appendage thrombus formation
Current data suggest that rhythm and rate control strategies are associated with similar rates of mortality and serious morbidity. As such, when would you choose a rhythm control strategy instead of rate control?
for symptom improvement with younger patient age in irreversible structural and electrical remodeling that occurs with longstanding persistent AF
AF is initiated by rapid firing (or triggers) from the _____.
pulmonary veins (PV)
AF is usually associated with some underlying heart disease. ____, ____, or _____ of the atria are often seen.
Atrial enlargement, an elevation in atrial pressure, or infiltration or inflammation
What is Long-standing persistent AF?
AF that has lasted for more than 12 months
AF is the most common cardiac arrhythmia. It has these characteristics: - RR interval: “irregularly irregular” - P wave: ______
absent
AF is more prevalent in ____ and _____.
men; with increasing age
If the AF is secondary to cardiac surgery, pericarditis, myocardial infarction (MI), hyperthyroidism, pulmonary embolism, pulmonary disease, or other reversible causes, therapy is directed toward ______.
the underlying disease as well as the AF
What can precipitate AF?
exercise emotion EtOH
AF is the most common cardiac arrhythmia. It has these characteristics: - RR interval: ______ - P wave: absent
“irregularly irregular”
AF can have adverse consequences related to a ______ and to atrial and atrial appendage thrombus formation.
reduction in cardiac output
What are the severe s/s of AF?
dyspnea at rest angina presyncope or infrequently, syncope an embolic event the insidious onset of right-sided heart failure
You verify the AF diagnosis. What now?
- determine need for anticoagulation therapy (CHA2DS2-VASC risk score) 2. decide rate vs rhythm control to slow the ventricular rate 3. cardioversion? 4. ablation?
How does the baseline appear in AF?
it’s undulating
AF is initiated by _____ from the pulmonary veins (PV).
rapid firing (or triggers)
In many cases, arrhythmia is triggered by _____ but is maintained by re-entry.
afterdepolarizations
What are the common rate control strategies in AF?
slow conduction across the atrioventricular (AV) node, using drugs like beta blockers, non-dihydropyridine calcium channel blockers (diltiazem or verapamil), or digoxin
For asymptomatic or mildly symptomatic AF patients who are 65 years or older, we suggest _____ strategy using medical therapy (Grade 2B).
a rate-control strategy
What are the common rhythm control strategies in AF?
antiarrhythmic drug therapy, percutaneous catheter ablation, and/or a surgical procedure
AF is a supraventricular ______.
tachycardia
This is AF that fails to self-terminate within seven days. Episodes often require pharmacologic or electrical cardioversion to restore sinus rhythm.
Persistent AF
What does “irregularly irregular” mean?
the spacing btw the R intervals is not uniform
In many cases, arrhythmia is triggered by afterdepolarizations but is maintained by _____.
re-entry
What are the typical s/s of AF?
palpitations tachycardia fatigue weakness dizziness lightheadedness reduced exercise capacity increased urination mild dyspnea
What is subclinical AF?
AF detected in asymptomatic individuals without a prior diagnosis- usually paroxysmal AF
For most patients with AF who are _____, particularly those who are symptomatic, we suggest a rhythm control strategy (Grade 2B).
younger than age 65
AF is usually associated with some underlying _____. Atrial enlargement, an elevation in atrial pressure, or infiltration or inflammation of the atria are often seen.
heart disease
AF that terminates spontaneously or with intervention within seven days of onset and having episodes that may recur with variable frequency is called?
Paroxysmal AF
What is Paroxysmal AF?
AF that terminates spontaneously or with intervention within seven days of onset. Episodes may recur with variable frequency.
For _____ or _____, we suggest a rate-control as opposed to a rhythm-control strategy using medical therapy (Grade 2B).
asymptomatic; mildly symptomatic AF patients who are 65 years or older
There will never be a _____ (heart sound) in A-fib, by definition.
S4
Early in the course of AF the atrium is relatively healthy and as a result _____.
sinus rhythm is spontaneously restored
What is Persistent AF?
AF that fails to self-terminate within seven days. Episodes often require pharmacologic or electrical cardioversion to restore sinus rhythm. While a patient who has had persistent AF can have later episodes of paroxysmal AF, AF is generally considered a progressive disease
______ and ______ are the most common underlying disorders in patients with atrial fibrillation (AF) in developed countries.
Hypertensive heart disease; coronary heart disease (CHD)
Name the 4 classifications of AF.
- Persistent AF 3, Long-standing persistent AF 4. Permanent AF
As the substrate remodels further over time, AF no longer _____ and becomes _____.
terminates spontaneously; persistent
This is persistent atrial fibrillation; no longer pursue a rhythm control strategy.
Permanent AF
If the AF is secondary to _____ (7), therapy is directed toward the underlying disease as well as the AF.
cardiac surgery pericarditis myocardial infarction (MI) hyperthyroidism pulmonary embolism pulmonary disease other reversible causes
What is the anticoagulant of choice for AF pts with a CHA2DS2-VASc score ≥2?
chronic warfarin or a NOAC (non-vitamin K oral anticoagulants like dabigatran, rivaroxaban, apixaban, or edoxaban)
AF almost always occurs in association with _____.
structural heart disease
What comorbidities may lead to AF?
cardiovascular or cerebrovascular disease diabetes hypertension chronic obstructive pulmonary disease hyperthyroidism excessive alcohol ingestion
What is the most frequent major complication of atrial fibrillation?
systemic embolization and stroke
