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IM > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

Atrial Fibrillation

A

Disorganized, rapid, and irregular atrial activation with loss of atrial contraction and with an irregular ventricular rate that is determined by AV nodal conduction

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2
Q

MC sustained arrhythmia

A

Atrial Fibrillation

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3
Q

AF in px <60 years old with the absence of clinical findings of other cardiovascular disease, related pulmonary disease or cardiac abnormalities

A

Lone AF

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4
Q

Defined by episodes that START SPONTANEOUSLY and STOP WITHIN 7 DAYS of onset

A

Paroxysmal AF

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5
Q

Often initiated by SMALL REENTRANT or rapidly firing foci in sleeves of atrial muscle that extend into the pulmonary veins (PV)

A

Paroxysmal AF

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6
Q

Present when AF episode either lasts > 7 days or requires termination by cardioversion

A

Persistent AF

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7
Q

Facilitated by STRUCTURAL AND ELECTROPHYSIOLOGIC ATRIAL ABNORMALITIES, particularly FIBROSIS that uncouples atrial fibers, promoting reentry and focal automaticity

A

Persistent AF

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8
Q

Lasted for ≥ 1 year when it is decided to adopt a rhythm control strategy

A

Long-standing Persistent AF

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9
Q

SIGNIFICANT FIBROSIS is usually present and it is difficult to restore and maintain sinus rhythm

A

Long-standing Persistent AF

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10
Q

Major Source of Thromboembolism and Stroke in AF

A

thrombus in the left atrial appendage

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11
Q

Arrhythmia induced by alcohol intoxication

A

Holiday Heart

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12
Q

Hallmark of AF

A

IRREGULARLY IRREGULAR PULSE

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13
Q

Management when the DURATION OF AF IS UNCLEAR or is known to be >48 h

A

anticoagulation must be commenced BEFORE cardioversion

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14
Q

Common practice in px who have NOT BEEN ANTICOAGULATED provided that they are NOT AT HIGH RISK FOR STROKE d.t. prior hx of embolic events, rheumatic mitral stenosis, or hypertrophic cardiomyopathy with marked left atrial enlargement

A

cardioversion within 48 h of the onset of AF

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15
Q

Drugs for Rate Control

A

B-blockers: metoprolol, bisoprolol, atenolol, esmolol, propranolol, carvedilol (Class II)

Non-dihydropyridine CCB: verapamil, diltiazem (Class IV)

Digoxin

Amiodarone
Dronedarone

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16
Q

Goal of acute rate control

A

Reduce the ventricular rate to <100/min –

17
Q

If adequate rate control in AF is DIFFICULT TO ACHIEVE, further consideration should be given to restoring sinus rhythm

A

catheter ablation of the AV junction

right ventricular apical pacing

biventricular pacing or direct pacing of the His bundle

18
Q

ANTICOAGULATION is warranted for px with

A

MS
HCOM
prior history of stroke

19
Q

Anticoagulant required for patients with RHEUMATIC MITRAL STENOSIS or MECHANICAL HEART VALVES

A

Warfarin

20
Q

Reversal agents of warfarin

A

fresh frozen plasma and vitamin K

21
Q

Reversal agent of dabigatran

A

Idarucuzimab

22
Q

Options for subjects WITH significant structural heart disease

A

Amiodarone (Class III)

23
Q

Options for subjects WITHOUT significant structural heart disease

A

Class I sodium channel–blocking agents (e.g., FLECAINIDE, PROPAFENONE, DISOPYRAMIDE)

24
Q

Can be administered to patients with CORONARY ARTERY DISEASE OR STRUCTURAL HEART DISEASE but have ~3% risk of inducing excessive QT PROLONGATION and TORSADES DES POINTES

A

Class III agents SOTALOL and DOFETILIDE

25
Q

More effective in maintaining SINUS RHYTHM and can be administered to patients with HF and CAD

A

Amiodarone

26
Q

CHA2DS2-VASc Score

A

determine the risk of having a stroke in the presence of AF

27
Q

CHA2DS2-VASc Score

A

estimates risk of ischemic stroke in patients w/ non-rheumatic/non-valvular AF

28
Q

CHA2DS2-VASc Score

A 
C - CHF/LVD - 1
H - HPN (>140/90 mmHg) - 1
A2 - age >75 years - 2
D - DM - 1
S2 - prior stroke/TIA/thromboembolism - 2
V - vascular disease (prior MI, PAD, aortic plaque)
A - 65-74 - 1
Sc - Female sex
29
Q

Non-Valvular AF

Males

A

CHA2DS2-VASc Score - 0 - no antiplatelet/anticoagulant
CHA2DS2-VASc Score - 1 - anticoagulant (Class IIa)
CHA2DS2-VASc Score - 2 - anticoagulant (Class I)
CHA2DS2-VASc Score - 3 - anticoagulant (Class I)

30
Q

Non-Valvular AF

Females

A

CHA2DS2-VASc Score - 0 - N/A
CHA2DS2-VASc Score - 1 - no antiplatelet/anticoagulant
CHA2DS2-VASc Score - 2 - anticoagulant (Class IIa)
CHA2DS2-VASc Score - 3 - anticoagulant (Class I)

31
Q

Valvular AF (mechanical heart valves, moderate to severe MS)

A

Warfarin

32
Q

Used for px with RECENT ONSET AF (<48 h) and with hemodynamic instability

A

Electrical cardioversion

IM (66 decks)

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