Atrial Fibrillation Flashcards
What is the most common cardiac dysrhythmia in clinical practice?
atrial fib
Which a-fib applies to patients <60 without clinical or ECHO evidence of cardiopulmonary disease?
Lone a-fib
Which a-fib is self-terminating, lasts <24 hrs) and can be recurrent?
Paroxysmal a-fib
Which a-fib is no self-terminating, lasts >7 days and can be recurrent?
Persistent a-fib
Which a-fib occurs when cardioversion fails?
Permanent a-fib
What are the Class III antiarrhythmics for pharmacological cardioversion?
Dofetilide, Ibutilide and Amiodarone
What are the Class I antiarrhythmics for pharmacological cardioversion?
Flecainide and Propafenone
Which Class of antiarrhythmics for pharmacological cardioversion should be avoided in patients with structural heart disease?
Class I
Which drugs are used for a-fib rate control in patients without an accessory pathway?
Esmolol (or if not sure b/c quick onset and short duration)
Metoprolol
Diltiazem
Verapamil
Which drug is used for rate control in patients with an accessory pathway like WPW?
Amiodarone
Which drugs are used for rate control with heart failure and without an accessory pathway?
Digoxin and Amiodarone
Which anti arrhythmic should be used with caution in patients with decreased renal function because or narrow T.I. and DDI?
Digoxin
Postoperative A-fib - DOC
oral beta blocker
alt. diltiazem or verapamil
AMI - treatment
DC cardioversion
IV amiodarone to slow RVR
IV beta blockers
UFH
WPW - a-fib treatment considerations
IV procainamide or ibutilide to restore sinus rhythm
Pregnancy - a-fib treatment
digoxin, a beta blocker or non DHP CCB
DC cardioversion
1st/3rd trimester UFH
2nd trimester Warfarin
Treatment acute a-fib (<48 hrs)
If not hemodynamically stable –> DC cardiovert
If stable –> pharmacologic cardioversion
No anticoagulation
Treatment acute a-fib (>48 hrs)
If not hemodynamically stable –> IV heparin + DC cardiovert
Continue Warfarin with INR 2-3 x 4 wks
If stable –> Warfarin INR 2-3 x 3 wks, DC cardiovert, continue Warfarin x 4 wks
Treatment chronic a-fib
- Attempt rate control first
2. risk assessment for antithrombotic therapy using CHADS2 score
Based on CHADS2 score…who gets ASA vs Warfarin?
0 ASA
1 ASA or Warfarin
2-6 Warfarin
(Warfarin is given when risk of stroke is higher than risk of bleeding)
Criteria for CHADS2 score
CHF (1 pt.) HTN (1 pt.) Age > 75 (1 pt.) DM (1 pt.) Stroke or TIA (2 pts.)
