Atrial Fib Flashcards
when does incidence of atrial fib increase?
-inc risk with age
What is the most common sustained arrhythmia in the USA?
-atrial fib
What causes atrial fib?
- atrial enlargement (mitral valve disease; rheumatic heart disease)
- ischemia
- toxins (ETOH, anticancer Tx)
- metabolic disease (hyperthyroidism)
- hemodynamic impairment (loss of atrial kick; tachyarrhythmia)
**Paroxysmal AF
- episodes may last 1-7 days (<24hrs)
- may be recurrent (2+ episodes)
**Persistent AF
- not self-limited (lasts longer than 7 days)
- paroxysmal when recurrent after reversion
**Permanent AF
- lasts over a year
- cardioversion either failed or not attempted
**Lone AF
- no overt cardiovascular pathology
- asymptomatic
- 10-15% all AF
Etiologies of AF
- HTN
- rheumatic heart disease
- valvular disease
- myocardial ischemia/infarction (CAD)
- alcoholism
- thyroid disease
- stroke
Symptoms of atrial fib
- palpitations
- sx of Heart failure (SOB, PND)
- asymptomatic
Physical exam of atrial fib
- irregularly irregular and NO P - WAVES
- variable intensity S1
- heart murmur (MS/MR)
- pulmonary rales/rhonchi
- portahepatic edema
- peripheral edema
ECG of atrial fib:
- irregularly irregular and NO P - WAVES
- f-waves (fibrillatory waves)
Hockey stick deformity on echo with?
- mitral stenosis
- atrial fib if mitral stenosis is also present
Who has increased risk for atrial fib?
- Age>65yo
- HTN
- rheumatic heart disease
- previous stroke or TIA
- diabetes mellitus
- congestive HF
AF - tx:
1) rhythm control - restore and maintian sinus rhythm
- improve symptoms
- improve hemodynamics
- reduce stroke risk
- avoid anticoagulation
2) rate control- maintain acceptable ventricular rate in chronic AF
Controlling rate or rhyhtm leads to lower mortality?
RATE CONTROL!
What did AFFIRM study show?
- rhythm control vs rate control showed no survival advantage
- stroke risk was similar between groups
- more drug adverse effects with rhythm control groups
AF and trying to control Rhythm results in
a lot of adverse drug effects! (AFFIRM STUDY)
- Suggestive approach to tx first AF event:
- Objectives of Tx:
1) evaluate for precipitating cause
2) clinical status determined initial Tx
3) Objectives of tx:
- Rhythm control-restore/maintain NSR
- rate control-maintain acceptable ventricular rate in chronic AF
- avoid embolic events
What is specific tx for rhythm control:
1) DC conversion to NSR prefered vs drug
2) urgent DC cardioversion needed if:
- current myocardial ischemia
- evidence of hypoperfusion
- severe heart failure symptoms
- pre-excitation present
3) pHarmacologic
- NOT PRIMARY CHOICE
- AF < 1week=dofetilide - first choice if we must go this route
- AF > 1 week = dofetillide, amiodarone, ibutilide
What is goal of tx for rate control?
- goal is to get HR to 80 - 110 (lenient rate control)
- avoid cardiomyopathy mediated by inc HR
What is prefered method for controlling AF?
-rate control
WHen to hospitalize AF paitent?
- if put on anticoags and need to monitor
- if need invasive procedure (ablasion)
- old people
- people with acute coronary syndrome
- people with other conditions such as cancer
-OTHERWISE SEND THEM HOME!
if cardioverting patient need to ..
keep them on antitrombotics for 3 weeks prior, during and 4 weeks agter cardioversion
contraindications for antithrombotics?
- under 60yo
- lone AF
Most common antithrombotics for AF?
- heparin
- warfarin
- aspirin (+ clopidogreL)
- rivaroxaban (super expensive)
Ablation what do they do?
-put catheter in heart and kill it with radiowaves –> give pacemaker then
