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Phar 505 > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

What is atrial fibrillation, what cardiovascular event is increased due to atrial fibrillation, how

A

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

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2
Q

What are the two causative elements introduce that increase the risk of atrial fibrillation

A

Atrial structure and electrical abnormalities

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3
Q

What are atrial structure changes that increase the risk of atrial fibrillation

A

Fibrosis, dilation, ischemia, infiltration, hypertrophy

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4
Q

What are electrical abnormalities that increase the risk of atrial fibrillation

A

Increased heterogeneity, lower conduction, shorter action potentials, increase autmaticity, abnormal calcium movement

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5
Q

What are primary contributors to atrial fibrillation

A

atrial tachycardia remodeling and RAAS activation

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6
Q

What is the major predictor atrial fibrillation, why

A

Sleep apnea, oxidative stress and may induce AFib development

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7
Q

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

A

Obesity, Hyperthyroidism, Hypertension, Alcohol/Drugs/ Hyperthyroidsim

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8
Q

What are ECG changes that that are present if a person has AFib

A

Irregular R-R intervals, absence of distinct repeating P waves, Irregular atrial activity

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9
Q

What are atrial bpm seen in someone with AFib, what are symptoms

A

SoB, dizziness, Fatigue, Palpations,

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10
Q

What are different categories of AFib and what are their definitions

A

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

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11
Q

What organ causes the paroxysmal AFib originally

A

Pulmonary vein

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12
Q

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

A

True

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13
Q

How do physicians know if the Afib caused the cardio myophathy or vice verse

A

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

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14
Q

T/F: Atrial Fibrillation has regular irregular rhythm characterized by similar R-R intervals and atrial activity looks the same on ECG

A

False: Atrial Fibrillation has irregular irregular rhythm characterized by different R-R intervals throughout, no recognizable P-waves and disorganization

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15
Q

What are the two options to treat a patient with AFib and what are key differences between the two

A

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

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16
Q

T/F: If a patient is doing rhythm control or rate control they should be on an anticoagulant regardless if they have AFib

A

True

17
Q

When would a patient be given a rate control regimen instead of rhythm control

A

No symptoms or minimal symptoms OR the patient has persistent or permanent atrial fibrillation

18
Q

What are the treatment options for rate control, what MUST be given as well

A

Beta-blockers, Non-DHP CCBs, Digoxin, Amiodarone, AV nodal ablation with pacemaker pacing/ Anticoagulants

19
Q

If a patient is given Rate control and is asymptomatic with normal left ventrical function what is the goal resting HR, symptomatic

A

Less than 110 bpm, less than 80 bpm

20
Q

When would a patient be given a rhythm control reigment

A

Patient has paroxymal or persistent AF, symptomatic patients despite adequte rate control, hemodynamically unstable, excarbeting heart failure

21
Q

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

A

True

22
Q

T/F: Pharmacological intervention the most effective way to have rhytmn control and can be initiated at anytime for the similar results

A

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

23
Q

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

A

Dofetilide, Dronedarone, Flecaindes, Propafenones, Sotalol/ Amiodarone due to the many adverse effects

24
Q

If a patient has structural heart disease along with their AFib what determines the medications they receive, what determinants get what medication

A

CAD and HF/ CAD: Dofetilide, Dronedarone, Sotalo with amiodarone as last line/ HF: Amiodarone and Dofetilide

25
Q

T/F: Catheter ablation is first line since it has the best efficacy

A

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

26
Q

What is the score used to asses the risk of stroke in patients with stroke and its categories

A 
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)
27
Q

What is considered vascular disease in the CHADSVAS score

A

MI, Previous CABG, Peripheral artery disease

28
Q

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

A

True

29
Q

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

A

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

30
Q

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

A

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

Phar 505 (33 decks)

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