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Clinical Medicine COPY > Atrial Fibrillation & Atrial Flutter > Flashcards

Atrial Fibrillation & Atrial Flutter Flashcards

1
Q

What type of rhythm is Atrial Fibrillation?

A

Irregularly irregular

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2
Q

Etiology of Atrial Fibrillation (name 3)

A
  • Acute hyperthyroidism
  • Acute vagotonic episode
  • Acute alcohol intoxication
  • Post-operatively after major surgery
  • Atrial enlargement
  • Disruption of electrical conduction system
  • Infiltration or inflammation of the atria
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3
Q

Where is the ectopic foci most often located in atrial fibrillation?

A

-Ectopic foci are most often located at the ostial portion of the pulmonary veins (site of ablation)

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4
Q

Risk factors of Atrial Fibrillation? (Name 3)

A
  • Age >64
  • Hypertension
  • Prolonged PR interval
  • Underlying heart disease
  • Heavy alcohol drinking
  • Family history
  • Obesity
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5
Q

What are the 5 Classification of Atrial Fibrillation? (describe)

A
  1. Paroxysmal (PAF) - intermittent
  2. Persistent - fails to self-terminate within 7 dys & requires intervention in order to convert
  3. Long-standing AF >12 months
  4. Permanent >12 months & no longer pursue rhythm control
  5. “Lone AF” – without structural heart disease, lowest risk of complications. (term not used much anymore)
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6
Q

Which heart valve is most often implicated in atrial fibrillation?

A

-Mitral valve

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7
Q

Symptoms of Atrial Fibrillation?

A
  • Asymptomatic
  • Heart palpitations
  • Light-headedness, pre-syncope, syncope
  • Shortness of breath & exercise intolerance
  • Chest pain (angina)
  • Fatigue
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8
Q

Triggers of Atrial Fibrillation?

A
  • Sleep deprivation
  • Physical illness
  • Post-surgery
  • Stress
  • Hyperthyroidism
  • Physical exertion/exercise
  • Stimulant medications (i.e. -Sudafed)
  • Alcohol
  • Caffeine
  • Dehydration
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9
Q

What is the approach to a patient with a new diagnosis of atrial fibrillation? (4 items)

A
  1. Control heart rate
  2. Consider rhythm control
  3. Determine risk of thromboembolism
  4. Look for underlying causes
    * Echocardiogram, *TSH
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10
Q

Describe atrial fibrillation on rhythm strip. (3 features)

A

narrow complexes, Irregularly irregular and no discernible p waves

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11
Q

Laboratory Testing for Atrial Fibrillation?

A
  • Thyroid-stimulating hormone (TSH) – all patients with first episode of afib or ↑frequency
  • Complete blood count (CBC)
  • Chemistries/electrolytes (including kidney function tests)
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12
Q

What type of diagnostic test will rule out an atrial thrombus?

A

-Transesophageal echocardiogram (TEE)

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13
Q

Therapy goals for Atrial Fibrillation?

A
  • Rhythm control (if not yet permanent)
  • Reduce the risk of stroke & other peripheral emboli (prevention of systemic embolization)
  • Prevent tachycardia mediated cardiomyopathy & ischemia (rate control)
  • Alleviate symptoms
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14
Q

Management Decisions for new Atrial Fibrillation (Afib)?

A
  • Is cardioversion indicated & should it be urgent?
  • Does the patient need rate control?
  • Does the patient need to be anticoagulated for embolization prevention?
  • Does the patient need to be hospitalized?
  • Are there correctable causes of afib
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15
Q

Indications for Urgent Direct Current (DC) Cardioversion?

A
  • Active ischemia
  • Unstable hemodynamics
  • Evidence of organ hypoperfusion
  • Severe manifestations of heart failure (pulmonary edema)
  • The presence of Wolf-Parkinson-White Syndrome)
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16
Q

Indications for non-urgent DC cardioversion?

A
  • New onset or newly recognized atrial fibrillation

- Patients with persistent AF who are limited by their symptoms

17
Q

Complications of rapid Atrial Fibrillation?

A
  • Symptoms
  • Ischemia
  • Pulmonary edema
  • Tachycardia induced cardiomyopathy
18
Q

Treatment for Atrial Fibrillation with RVR?

A
  • Beta-Blockers (BBs)
  • Calcium Channel Blockers
  • Digoxin
  • Amiodarone
19
Q

Beta-Blockers for treatment of rapid Atrial Fibrillation with RVR?

A

-Immediate control
(IV Metoprolol (start 5mg IVP), IV Propranolol)
-Chronic BB therapy (Oral Atenolol (once daily dosing), Oral Metoprolol (typically twice daily dosing or long acting Toprol Xl once daily), Oral Nadolol (liver failure patients), Oral Carvedilol (heart failure patients))

20
Q

Calcium Channel Blockers (CCBs) for rapid Atrial Fibrillation?

A
  • Immediate control (IV Diltiazem (start 10-15mg IVP), IV Verapamil)
  • Chronic CCB therapy (Oral Verapamil, Oral Diltiazem)
21
Q

Digoxin for rapid Atrial Fibrillation?

A
  • less effective for rate control particularly during exercise
  • Can be added to beta-blockers if insufficient or intolerant
  • Initial dose is, “loading dose” (higher) then daily, “maintenance dose”
  • Plasma digoxin levels should be monitored periodically (risk of dig toxicity)
22
Q

Amiodarone for rapid Atrial Fibrillation?

A
  • Maintains sinus rhythm in AF patients (antiarrhythmic)
  • Can slow rate for refractory afib with RVR after maximizing BB, & CCB
  • Immediate use: IV
  • Long term maintenance: oral (PO)
  • Less likely to cause hypotension
  • Side effects: abnormal liver function tests (LFTs), pulmonary toxicity (interstitial pneumonitis)
23
Q

Anticoagulation for embolization prevention?

A
  • Warfarin (Coumadin)
  • Dabigatran (Pradaxa)
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
24
Q

Warfarin (Coumadin) for atrial fibrillation?

A

depletes functional vitamin K reserves and hence reduces synthesis of many active clotting factors, gives Full therapeutic effect in 5-7 days

25
Q

Atrial Flutter

A
  • Less common than Atrial fibrillation
  • 88 per 100,000 persons per year
  • 200,000 new cases per year
  • Men > Women
  • Sometimes leads to afib
  • occurs after initiation of an antiarrhythmic drug for afib
  • Associated with left atrial enlargement
  • Usually rapid (ventricular rate ~150bpm)
  • Atrial rate ~250-350bpm (F waves)
26
Q

Associated Disorders with Atrial Flutter?

A
  • Hyperthyroidism
  • Heart failure
  • Obesity
  • Obstructive sleep apnea
  • Sick sinus syndrome
  • Pericarditis
  • Pulmonary disease
  • Pulmonary embolism
27
Q

Treatment considerations of Atrial Flutter?

A
  • Control ventricular rate
  • Convert to normal sinus rhythm (NSR)
  • Maintain normal sinus rhythm
  • Prevention of systemic embolization
28
Q

Pharmacologic Therapy for conversion to sinus rhythm?

A
  • Flecainide
  • Sotalol
  • Dofetilide
  • Amiodarone
  • Propafenone
29
Q

What is happening in the atria during atrial fibrillation?

A
  • Disorganized, rapid (~250 atrial contractions/min) and irregular atrial activation
  • Loss of effective atrial contractility
30
Q

Name 3 complications of atrial fibrillation

A
  1. Often results in rapid heart rate (120-160 bpm)
  2. Rapid afib can cause pulmonary edema
  3. Leads to clot formation in the heart chamber and subsequent thromboembolic events (leading cause of stroke)

Clinical Medicine COPY (23 decks)

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