Atrial Fibrillation Flashcards
definition of AF
- irregularly irregular ventricular rhythm
- rate of 80-170
- NO P waves in any leads
the presence of these 2 findings on ECG RULES OUT AF
- deformed T waves “hiding” P waves
2. deformed ST segments “hiding” P waves
do NOT confuse AF w/
- ST w/ PACs
- MAT in pts w/ COPD
- Mobitz thype 1 second-degree AVB w/ group-beating
- arrhythmia d/t digitalis toxicity (AT w/ block)
AF can mimic VF in what setting?
irregular, wide-complex tachycardia
- underlying intraventricular conduction delay (RBBB)
- accessory pathway
diagnostic studies for AF
- serum TSH
- digoxin level (if appropriate)
- pulse ox
- echocardiography
tx for AF
chronic AC
r/o stroke in pts w/ nonvalvular AF plus one other risk factor exceeds r/o what?
hemorrhage from AC
AC goals in AF:
- CHADS2 score = 0
aspirin
AC goals in AF:
- CHADS2 score = 1
individual assessment
AC goals in AF:
- CHADS2 score = 2 or more
warfarin; INR 2-3
CHA2DS2-VASc: 1 point given for
- HF
- HTN
- DM
- vascular dz (h/o MI, PAD, aortic plaque)
- female
- ages 65-74
CHA2DS2-VASc: 2 points given for
- h/o CVA, TIA, or VTE
- age 75 or older
how are all the DOACs cleared?
renally
DOACs are CI in which pts?
ESRD
why is bridging not required for AF when starting AC, including when AC is interrupted for procedures?
daily r/o stroke is low
tx for hemodynamically unstable AF
electrical cardioversion
when should AC be given for elective electrical cardioversion of AF?
if AF > 48 hours or unknown duration
for how long should AC be given prior to elective electrical cardioversion of AF?
is there an alternative?
- 3 weeks
- TEE to r/o clot
do pts need AC after elective electrical cardioversion of AF?
- yes, for at least 4 weeks
- or chronically depending on risk factors
is there any apparent mortality benefit of rhythm control over rate control?
no
which meds should be used on older pts w/ chronic AF or AF of unknown duration?
- diltiazem
- verapamil
- atenolol
- metoprolol
is there any improvement in clinical outcomes if ventricular resting rate is < 80 bpm vs < 110 bpm?
NO
when is rhythm control appropriate?
younger pts w/ persistent symptomatic AF
if rhythm control w/ meds is unsuccessful?
catheter ablation
if infrequent paroxysmal AF
“pill-in-pocket” approach: flecainide or propafenone w/ BB or CCB
DON’T BE TRICKED
- what is the ONLY medication indicated for AF 2/2 valvular heart disease?
WARFARIN
DON’T BE TRICKED
- what agent should NOT be used as a single agent for rate control?
digoxin
DON’T BE TRICKED
- in which pts should CCBs, BBs, and digoxin NOT be started and which med should be started instead?
- AF and WPW syndrome
- procainamide
