Atrial Fibrillation

Question 1

What is the most common cardiac dysrhythmia in clinical practice?

Answer 1

atrial fib

Question 2

Which a-fib applies to patients <60 without clinical or ECHO evidence of cardiopulmonary disease?

Answer 2

Lone a-fib

Question 3

Which a-fib is self-terminating, lasts <24 hrs) and can be recurrent?

Answer 3

Paroxysmal a-fib

Question 4

Which a-fib is no self-terminating, lasts >7 days and can be recurrent?

Answer 4

Persistent a-fib

Question 5

Which a-fib occurs when cardioversion fails?

Answer 5

Permanent a-fib

Question 6

What are the Class III antiarrhythmics for pharmacological cardioversion?

Answer 6

Dofetilide, Ibutilide and Amiodarone

Question 7

What are the Class I antiarrhythmics for pharmacological cardioversion?

Answer 7

Flecainide and Propafenone

Question 8

Which Class of antiarrhythmics for pharmacological cardioversion should be avoided in patients with structural heart disease?

Answer 8

Class I

Question 9

Which drugs are used for a-fib rate control in patients without an accessory pathway?

Answer 9

Esmolol (or if not sure b/c quick onset and short duration)
Metoprolol
Diltiazem
Verapamil

Question 10

Which drug is used for rate control in patients with an accessory pathway like WPW?

Answer 10

Amiodarone

Question 11

Which drugs are used for rate control with heart failure and without an accessory pathway?

Answer 11

Digoxin and Amiodarone

Question 12

Which anti arrhythmic should be used with caution in patients with decreased renal function because or narrow T.I. and DDI?

Answer 12

Digoxin

Question 13

Postoperative A-fib - DOC

Answer 13

oral beta blocker

alt. diltiazem or verapamil

Question 14

AMI - treatment

Answer 14

DC cardioversion
IV amiodarone to slow RVR
IV beta blockers
UFH

Question 15

WPW - a-fib treatment considerations

Answer 15

IV procainamide or ibutilide to restore sinus rhythm

Question 16

Pregnancy - a-fib treatment

Answer 16

digoxin, a beta blocker or non DHP CCB
DC cardioversion
1st/3rd trimester UFH
2nd trimester Warfarin

Question 17

Treatment acute a-fib (<48 hrs)

Answer 17

If not hemodynamically stable –> DC cardiovert
If stable –> pharmacologic cardioversion
No anticoagulation

Question 18

Treatment acute a-fib (>48 hrs)

Answer 18

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

Question 19

Treatment chronic a-fib

Answer 19

1. Attempt rate control first

2. risk assessment for antithrombotic therapy using CHADS2 score

Question 20

Based on CHADS2 score…who gets ASA vs Warfarin?

Answer 20

0 ASA
1 ASA or Warfarin
2-6 Warfarin
(Warfarin is given when risk of stroke is higher than risk of bleeding)

Question 21

Criteria for CHADS2 score

Answer 21

CHF (1 pt.)
HTN (1 pt.)
Age > 75 (1 pt.)
DM (1 pt.)
Stroke or TIA (2 pts.)