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Cardiology > Atrial Fibrillation and Flutter > Flashcards

Atrial Fibrillation and Flutter Flashcards

1
Q

Paroxysmal atrial fibrillation

A

Self-termination within 7 days (includes those cardioverted within 7 days).

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2
Q

Persistent atrial fibrillation

A

Continuous atrial fibrillation lasting longer than 7 days.

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3
Q

Long-standing persistent atrial fibrillation

A

Continuous atrial fibrillation lasting longer than 12 months.

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4
Q

Permanent atrial fibrillation

A

Term used when decision is made to stop further attempts to restore and/or maintain sinus rhythm.

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5
Q

Consider adjunctive use of ___ when able prior to electrical cardioversion

A

Amiodarone.

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6
Q

Pre-procedure anticoagulation is not required prior to cardioversion for those who have been in Afib for less than ___.

A

48 hours.

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7
Q

Individuals who have been in atrial fibrillation for greater than ___ must anticoagulate for at least ___ prior to DCCV (or a TTE must be obtained).

A

48 hours.

3 weeks.

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8
Q

All individuals should anticoagulate for at least ___ following DCCV due to risk of myocardial stunning.

A

4 weeks.

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9
Q

Management of atrial fibrillation in tachycardic but otherwise hemodynamically stable patients:

A
  1. Beta-blockers (metoprolol, labetalol, propranolol, esmolol).
  2. Calcium channel blockers (diltiazem, verapamil).
    * Start with IV, then follow with PO.
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10
Q

Management of atrial fibrillation in tachycardic but hemodynamically tenuous patients:

A
  1. Low-dose beta-blocker or calcium channel blocker.
  2. Digoxin load (contraindicated with accessory pathways).
  3. Amiodarone bolus/load.
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11
Q

Management of atrial fibrillation in tachycardic and hemodynamically unstable patients:

A
  1. DCCV.

2. Phenylephrine (causes reflex bradycardia).

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12
Q

___ blockers are more successful than ___ blockers at achieving rate control.

A
  1. Beta.

2. Calcium channel.

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13
Q

Digoxin is effective at rate control only with ___.

A

Rest. Not effective when the patient is exerting themselves.

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14
Q

Long-term digoxin is associated with ___ in atrial fibrillation patients.

A

Increased mortality.

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15
Q

Target rate in patients with atrial fibrillation:

A

<110 bpm, which has been shown to be non-inferior to stricter rate control (HR <80 bpm).

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16
Q

Calcium channel blockers should be avoided in patients with an EF

A

40%.

17
Q

First-line antiarrhythmic in patients with pre-excitation on EKG:

A

Procainamide.

18
Q

Long-term rhythm control in patients with CAD:

A
  1. Dofetilide.
  2. Dronedarone.
  3. Sotalol.
  4. Amiodarone.
19
Q

Long-term rhythm control in patients with CHF:

A
  1. Amiodarone.

2. Dofetilide.

20
Q

Long-term rhythm control in patients with LVH:

A
  1. Amiodarone.

2. Dofetilide.

21
Q

Long-term rhythm control in patients with no structural heart disease:

A
  1. Flecainide/propafenone.
  2. Dofetilide.
  3. Dronedarone.
  4. Sotalol.
  5. Amiodarone.
22
Q

Options for chemical cardioversion:

A
  1. Flecainide/propafenone.
  2. Dofetilide.
  3. Ibutilide.
  4. Amiodarone.
23
Q

Components of the CHADS2-VASc score:

A 
CHF (1)
HTN (1)
Age 65-74 (1)
DM (1)
Female sex (1)
Vascular disease (1)
Age >75 (2)
Stroke/TIA (2)
24
Q

Management of CHADS2-VASc of 0:

A

No anticoagulation.

25
Q

Management of CHADS2-VASc of 1:

A

No anticoagulation vs ASA vs anticoagulation.

26
Q

Management of CHADS2-VASc of 2+:

A

Anticoagulation.

27
Q

HAS-BLED score components:

A 
HTN (SBP >160) (1)
Abnormal renal/hepatic function (CrCl <50, Cirrhosis, Bili >2x ULN, AST/ALT/ALP >3x ULN) (1)
Stroke (1)
Bleeding history (1)
Labile INR (<60% in Rx range) (1)
Elderly (>65 years) (1)
Drugs (ASA, NSAIDs, EtOH) (1)
28
Q

HAS-BLED score greater than ___ should prompt closer monitoring in the outpatient setting.

A

3.

29
Q

Rate control options for atrial flutter:

A

Beta-blockers and calcium channel blockers. More difficult to successfully control than atrial fibrillation.

30
Q

Rhythm control options for atrial flutter:

A

Cavo-tricuspid isthmus (CTI) ablation for type 1 (typical) flutter. >90% effective at one year.

31
Q

Anticoagulation guidelines for atrial flutter:

A

Treat like atrial fibrillation.

32
Q

Characteristics of counterclockwise flutter waves:

A

Inverted in II, III, and aVF. Upright in V1.

33
Q

Characteristics of clockwise flutter waves:

A

Upright in II, III, and aVF. Inverted in V1.

Cardiology (2 decks)

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