Atrial Fibrillation Flashcards
What is atrial fibrillation, what cardiovascular event is increased due to atrial fibrillation, how
Ecstatic quivering motion due to rapid irregular firing causing flow of blood from the atriums is slowed and disfigured/ Stroke due to blood blood being left static and being prone to clot
What are the two causative elements introduce that increase the risk of atrial fibrillation
Atrial structure and electrical abnormalities
What are atrial structure changes that increase the risk of atrial fibrillation
Fibrosis, dilation, ischemia, infiltration, hypertrophy
What are electrical abnormalities that increase the risk of atrial fibrillation
Increased heterogeneity, lower conduction, shorter action potentials, increase autmaticity, abnormal calcium movement
What are primary contributors to atrial fibrillation
atrial tachycardia remodeling and RAAS activation
What is the major predictor atrial fibrillation, why
Sleep apnea, oxidative stress and may induce AFib development
What are other extracardiac factors that increase the risk of AFib, which is of these can be treated and significantly reduce the risk of AFib
Obesity, Hyperthyroidism, Hypertension, Alcohol/Drugs/ Hyperthyroidsim
What are ECG changes that that are present if a person has AFib
Irregular R-R intervals, absence of distinct repeating P waves, Irregular atrial activity
What are atrial bpm seen in someone with AFib, what are symptoms
SoB, dizziness, Fatigue, Palpations,
What are different categories of AFib and what are their definitions
Paroxysmal AFib: Terminates spontaneously with or without intervention in less than 7 days with returning variability
Persistent AFib: Continuous and sustained AFib for greater than 7 days
Long Standing Persistent AFib: Continuous and sustained AFib for greater than 1 year
Permanent AFib: Attempts to restore normal sinus rhythm have been abandoned
What organ causes the paroxysmal AFib originally
Pulmonary vein
T/F: Patients are five times more likely to get a stroke and three times more likely to have heart failure if they have AFib
True
How do physicians know if the Afib caused the cardio myophathy or vice verse
If the patient is put in sinus rthymn or beats less than 110 or even 80 and the cardio myopathy is gone within months it was originally started by the AFib, if not the patient has that myopathy regardless of AFib
T/F: Atrial Fibrillation has regular irregular rhythm characterized by similar R-R intervals and atrial activity looks the same on ECG
False: Atrial Fibrillation has irregular irregular rhythm characterized by different R-R intervals throughout, no recognizable P-waves and disorganization
What are the two options to treat a patient with AFib and what are key differences between the two
Rhythm Control: Putting the patient back into normal rhythm and eliminating the atrial fibrillation
Rate Control: Patient stays in AFib and slowing down the ventricular response
T/F: If a patient is doing rhythm control or rate control they should be on an anticoagulant regardless if they have AFib
True
When would a patient be given a rate control regimen instead of rhythm control
No symptoms or minimal symptoms OR the patient has persistent or permanent atrial fibrillation
What are the treatment options for rate control, what MUST be given as well
Beta-blockers, Non-DHP CCBs, Digoxin, Amiodarone, AV nodal ablation with pacemaker pacing/ Anticoagulants
If a patient is given Rate control and is asymptomatic with normal left ventrical function what is the goal resting HR, symptomatic
Less than 110 bpm, less than 80 bpm
When would a patient be given a rhythm control reigment
Patient has paroxymal or persistent AF, symptomatic patients despite adequte rate control, hemodynamically unstable, excarbeting heart failure
T/F: The first time Afib is seen rhythm control should be considered because the longer AFib is present the more likely it will get worse, especially in younger patients
True
T/F: Pharmacological intervention the most effective way to have rhytmn control and can be initiated at anytime for the similar results
False: Pharmcological rthymn control is least effective compared to electrical cardioversion but if initiated within 7 days after the onset of arrhythmia patients can have the most benefit
If a patient has no strucutuarl heart disease with their AFib what are the first line drugs that should be used, last line and why
Dofetilide, Dronedarone, Flecaindes, Propafenones, Sotalol/ Amiodarone due to the many adverse effects
If a patient has structural heart disease along with their AFib what determines the medications they receive, what determinants get what medication
CAD and HF/ CAD: Dofetilide, Dronedarone, Sotalo with amiodarone as last line/ HF: Amiodarone and Dofetilide
T/F: Catheter ablation is first line since it has the best efficacy
False: Catheter ablation should only be used on symptomatic paroxysmal Afib and refractory patients that are intolerant to at least 1 class 1 or 3 antiarrhythmic medication when a rhythm control strategy is desired
What is the score used to asses the risk of stroke in patients with stroke and its categories
C: Congestive Heart Failure H: Hypertension A: Greater than or equal to 75 D: Diabetes S: Stroke (previous) V: Vascular disease A: age 65-74 years old S: Sex (female)
What is considered vascular disease in the CHADSVAS score
MI, Previous CABG, Peripheral artery disease
T/F: If a patient has a CHADSVAS score of zero they will not receive anticoagulants with their AFib treatment but it a patient has a score greater than or eqaul to one they will receive anticoagulation as well
True
If a patient who has had AFib for less than 48 hours and is presenting for cardioversion what are the steps for treatment, what should be done if normal sinus rhythm is restored, sinus rhythm is not restored
1) Anticoagulate with Heparin
2) Apply Direct Current Cardioversion/ If sinus rthymn is restored the patient should asses their risk of stroke and if it is high anticoagulation should be given for 4 weeks but if NO risk anticoags are not needed
If a patient who has had AFib for greater than 48 hours and is presenting for cardioversion what are the two reasons and how does it affect the treatment
Emergency: Use TEE to check for thrombus, given Heparin and then cardiovert, then give 4 weks of oral anticoagulants
Change: 3 weeks for oral anticoags prior to cardioversion, then 4 weeks of oral anticoags for 4 weeks after post-cardioversion
