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clin med - cardio exam #2 > Atrial Flutter & Fibrilation > Flashcards

Atrial Flutter & Fibrilation Flashcards

1
Q

define a.fib

A

disorganized, rapid, and irregular atrial contraction

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2
Q

What does a.fib result in?

A
  • non-effective contractility
  • irregular ventricular response
  • tachycardia (120-160bpn)
  • thrombus/clot
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3
Q

What is the MC arrhythmia?

A

a.fib

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4
Q

What is the MC cause of TIA?

A

a.fib

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5
Q

epidemiology of a.fib

A
  • 65+ y/o

- males more than females

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6
Q

etiology of a.fib

A

often related to stretching

  • hyperthyroidism
  • vagotonic episodes
  • ETOH toxicity
  • post-op
  • atrial enlargement d/t end stage R heart failure
  • disruption of electrical conduction system
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7
Q

pathophysiology of a.fib

A
  • incr atrial pressure
  • triggered by atrial premature beats or other supraventricular arrhythmia
  • ectopic foci most commonly located at osteal portion of pulm. v.
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8
Q

risk factors for a.fib

A
  • 64+ y/o male
  • HTN
  • incr BMI
  • prolonged PR interval
  • valvular dz
  • CHF
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9
Q

classifications of a.fib

A
  • paroxysmal (PAF)
  • persistent
  • permanent
  • “Lone”
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10
Q

describe PAF

A

intermittent

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11
Q

describe persistent a.fib

A
  • does not self-terminate w/in 7d

- requires intervention to convert

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12
Q

describe permanent a.fib

A

12+ mo

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13
Q

describe Lone a.fib

A
  • without structural heart disease

- lowest risk of complications

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14
Q

diseases associated with a.fib

A
  • valvular dz (sig. stenosis/regurg and rheumatic heart dz)
  • heart failure d/t dilation
  • hypertensive heart disease
  • acute MI
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15
Q

symptoms of a.fib

A
  • asx
  • heart palpitations
  • lightheadedness, pre-syncope, syncope d/t decr BP and incr HR
  • SOB + DOE
  • chest pain (rare)
  • fatigue
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16
Q

common triggers of a.fib

A
  • sleep deprivation
  • physical illness
  • post-op
  • stress
  • hyperthyroidism
  • exercise
  • stimulant rx
  • ETOH
  • caffeine
  • dehydration
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17
Q

initial presentation of new onset a.fib

A
  • heart palpitations
  • fatigue
  • SOB
  • angina
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18
Q

physical exam of a.fib

A
  • decr. BP, incr. HR
  • irregularly irregular pulse (check for DVT)
  • murmurs
  • evidence of heart failure (incr. JVP, crackle, edema)
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19
Q

diagnostics for a.fib

A
  • EKG = no p waves, irregularly irregular rhythm
  • TTE
  • TEE (prior to cardioversion)
  • exercise stress test (CAD)
  • heart monitors
20
Q

labs for a.fib

A
  • TSH
  • CBC
  • BMP
21
Q

goals of therapy for a.fib

A
  • rhythm control
  • decr risk of TIA/emboli
  • rate control
  • alleviate sx
22
Q

indications for urgent DC cardioversion for a.fib

A
  • active ischemia
  • unstable hemodynamics
  • organ hypoperfusion
  • severe manifestations of heart failure (pulm edema)
  • WPW syndrome (delta waves)
23
Q

indications for non-urgent DC cardioversion fo a.fib

A
  • new onset or newly recognized

- persistent a.fib who are limited by their sx

24
Q

indications NOT to DC cardiovert for a.fib

A
  • minimally sxatic
  • multiple co-morbidities
  • pts unlikely to remain NSR
  • 80+ y/o
  • paroxysmal a.fib
25
Q

Prior to _____ for a.fib, control _____ rate and provide _____.

A

Prior to cardioversion for a.fib, control ventricular rate and provide IV heparin.

26
Q

patient presents with a.fib for less than 48 hrs, what do you do?

A

heparin + rate control then cardiovert

27
Q

patient presents with a.fib for more than 48 hrs, what do you do?

A

Option 1: oral anticoags x3wk then cardiovert

Option 2: TEE

28
Q

patient presents with a.fib for more than 48 hrs and you’ve decided to get at TEE, what are you looking for and what do you do if you find it or not?

A

No thrombus ==> heparin + cardioversion

Thombus ==> oral anticoags x3wks

29
Q

patient presented 3 weeks ago with a.fib of more than 48hrs for which you got a TEE and saw a thrombus, now what do you do?

A

repeat TEE

  • No thrombus ==> cardioversion
  • thrombus ==> long term anticoags + NO cardioversion
30
Q

complications of a.fib with rapid ventricular rate (150+ bpm)

A
  • heart palpitations, fatigue, SOB, etc
  • ischemia
  • pulm edema
  • tachycardia induced cardiomyopathy
31
Q

components of the CHA2DS2-VASc

A
  • CHF
  • HTN
  • Age
  • DM
  • Stoke
  • vascular dz
32
Q

pharmacologic tx of a.fib

A
  • Beta-blocker (metoprolol)
  • CCB (diltiazem)
  • digoxin
  • amiodarone
33
Q

How is digoxin rx’d?

A
  • with beta-blocker

- loading + maintenance dose

34
Q

What is the MC toxicity with amiodarone?

A
  • pulm: chronic interstitial pneumonitits
35
Q

anticoag for emboli formation

A
  • warfarin (Coumadin)
  • dabigatran
  • rivaroxaban
  • apixaban
36
Q

When to bridge warfarin with heparin/LMWH

A
  • not usually for a.fib
  • recent/ongoing TIA/embolus
  • known arterial thrombus
  • current hospital stay
37
Q

indications for hospitalization with a.fib

A
  • immediate bridge anticoagulants
  • ablation
  • tx of other medical conditions
  • management of rate/sick sinus syndrome
38
Q

What are the indications for ablation therapy?

A

a.fib + WPW

39
Q

definition of a. flutter

A

one ectopic foci produces electrical circuit that goes around the tricuspid valve

40
Q

epidemiology/etiology of a.flutter

A
  • less common than a.fib but can lead to it
  • s/p antiarrhythmic rx for a.fib tx
  • associated with LA enlargement
41
Q

ventricular/atrial rate of a.flutter

A
  • ventricular = ~150bpm

- atrial = ~250-350 bpm

42
Q

associated disorders of a.flutter

A
  • hyperthyroidism
  • heart failure
  • obesity
  • OSA
  • sick sinus syndrome
  • pericarditis
  • pulm dz or embolism
43
Q

clinical manifestations of a.flutter

A
  • palpitations
  • lightheadedness
  • SOB
  • tachycardia
  • evidence of CHF
44
Q

diagnostics of a.flutter

A
  • EKG
  • TTE
  • TEE if preparing to cardiovert
  • exercise stress
45
Q

complications of a.flutter

A
  • heart ischemia
  • pulm edema
  • tachycardia induced cardiomyopathy
  • thromboembolism
46
Q

treatment goals of a.flutter

A
  • control ventricular rate
  • convert to and maintain NSR
  • prevent systemic embolism
47
Q

treatment options of a.flutter

A
  1. rate control
    - more difficult than a.fib
    - beta-blocker, CCB,digoxin, ablation
  2. convert to NSR
    - antiarrhythmics
  3. anticoagulants
    - recurrent a.flutter or a.fib after ablation
    - indefinite w/ CHADS2 score = 1+

clin med - cardio exam #2 (12 decks)

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