Atrial Arrhythmias Flashcards
1
Q
Afib Patho
A
- Atrial Structure Abnormalities: atrial dilation (increased pressure, heart failure), fibrosis, ischemia
- Inflammation, oxidative stretch
- Hyperthyroidism
- Alcohol and drug use
- Genetic variants
- Need to assess patients for rate and rhythm control and stroke prevention when deciding treatments
2
Q
Afib Risk Factors
A
- Hypertension
- Heart disease, esp heart failure
- Hyperthyroidism
- Excessive to moderate alcohol
- Obesity
- Sleep apnea
- Fish oil?
- Non modifiable: age
3
Q
Afib Symptoms
A
- Palpitations (Plus SOB/lightheaded = triad)
- Fatigue
- Syncope
- Dyspnea
- Dizziness
- Angina
- OR no noticeable symptoms at all
4
Q
Types of AF
A
- Paroxysmal AF: terminates spontaneously or w/ intervention within 7 days of onset, may recur variably
- Persistent AF: continuously sustained >7 days
- Long-standing persistent AG: continuously > 12 mo in duration
- Permanent AF
- Nonvalvular AF: absence of rheumatic mitral stenosis, mechanical/bioprosthetic heart value or mitral valve repair
5
Q
Permanent AF
A
- Used when patient/clinician make joint decision to stop further attempts to restore and/or maintain sinus rhythm
- Acceptance of AF represents therapeutic attitude on part of patient/clinician instead of inherent pathophysiological attribute of AG
- Acceptance may change symptoms, efficacy of interventions, and patient/clinician preferences evolve
6
Q
Rate Control Approach
A
- Anticoagulation + ventricular rate control
- No cardioconversion, patient remains in Afib indefinitely
- AA NOT used, only drugs that slows conduction through AV node
- Decrease ventricular response rate, reasonable for symptomatic management of AF (resting HR < 80)
- Lenient rate-control strategy (resting HR < 110) may reasonable as long as patient remains asymptomatic and LV systolic fxn is preserved
- Use drugs that decrease AV node conduction
7
Q
Rhythm-control Approach
A
- Anticoagulation + ventricular control + AA
- AA or DCC are used to cardiovert patient to normal rhythm
- AA or catheter ablation are then used to maintain normal rhythm
- Rate controlling drugs are frequently maintained in event of breakthrough episodes of Afib
8
Q
Rhythm vs Rate Control
A
- Rate control may be only option in some patient in which normal rhythm can’t be maintained (permanent AF) or due to AE of drugs/risks
- Rhythm control is preferred in patient with symptoms despite rate control, including those with persistent symptoms of HF
- Outcomes appear to be similar between the two approaches
9
Q
Rate Control General Monitoring
A
- Ventricular response rate: measure pulse
- BP: most rate control drugs can decrease BP
- Ca+ channel blockers can cause constipation/heart burn
- B-blockers can cause fatigue and decrease exercise tolerance
- Digoxin Monitoring
10
Q
Digoxin Monitoring
A
- Monitor serum levels: <1 is best, take [trough], bad if >1.5
- Monitor bradycardia
- N/V, halo vision
- Caution in renal dysfxn
- Hypokalemia can increase toxicity
- Toxicity can lead to fatal brady/tachyarrhythmias
11
Q
Rhythm Control General Monitoring
A
- Need to monitor for AE and DDI for AA selected (QTc monitoring, or warfarin + amiodarone)
- Afib Burden: how often do patients go back into Afib
12
Q
Pill-In-Pocket
A
- Option for those doing rhythm control method
- Self administer single pill of AA at onset of palpitations
- Class IC flecainide and propafenone act rapidly and are effective
- Combine with B-blocker or non-dihydropyridine CCB
13
Q
Afib + Stroke
A
- Inadequate blood flow in areas => blood clot
- Blood clots dislodge and travel to brain
- Leads to stroke
14
Q
Stroke Risk Scores
A
- CHADS2 or CHA2DS2-VASc (recommended to use nonvalvular AF)
- All use selected clinical characteristics to predict the risk of stroke
- All scores provide a rough estimate of risk of thrombosis in a population at similar risk as patient being reviewed
15
Q
IV to PO Transistion
A
- Need to convert patients from IV to PO before discharge
- Different anticoagulants will have different approaches
- Start warfarin while on heparin (takes days to work)
- Transition to NOAC usually requires stopping IV heparin and starting NOAC at same time (check drug info sources)
