C251 Atrial Fibrillation Flashcards
Most commom sustained arrythmia
Afib
Typical range of heartbeat in Afib
110-160 bpm
How many percent ng cardiac surgery post op patients ang nag AF
30%
Kelan magiging paroxysmal vs persistent vs longstanding persistent AF
Heart thrombus occurs primarily in
Left atrial appendage
Is tachycardia-induced cardiomyopathy reversible
Yes
Which chamber of the heart is most dilated in AF
left atrium
Drug used for Pharmacologic cardioversion of AF
ibutilide (class 3 antiarrhythmic)
Ibutilide should be avoided in patients with _________or _____________, given the risk of torsades des pointes.
Ibutilide should be avoided in patients with baseline prolonged QT interval or Severe left ventricular dysfunction, given the risk of torsades des pointes.
It is presumed that if the presenting episode of AF is >48 h or if the episode duration is unknown, there is risk for precipitating a thromboembolic complication through cardioversion, whether electrical or pharmacologically achieved.
Therefore, in this circumstance, the patient should be either
(1) _____ or
(2) _________
It is presumed that if the presenting episode of AF is >48 h or if the episode duration is unknown, there is risk for precipitating a thromboembolic complication through cardioversion, whether electrical or pharmacologically achieved.
Therefore, in this circumstance, the patient should be either
(1) initiated on anticoagulation, with cardioversion deferred for at least 4 weeks after uninterrupted anticoagulation, or (2) evaluated to exclude the presence of left atrial appendage thrombus.
f the duration of AF exceeds 48 h or is unknown, there is greater concern for thromboembolism after cardioversion, even in patients considered low risk
There are 2 approaches to mitigate the risk r/t cardioversjon. What…
f the duration of AF exceeds 48 h or is unknown, there is greater concern for thromboembolism after cardioversion, even in patients considered low risk
There are 2 approaches to mitigate the risk r/t cardioversjon.
(1) One option is to anticoagulate continuously for
eeks before and a minimum of 4 weeks after cardioversion.
(2) second approach is to start anticoagulation and perform a TEE or high-resolution cardiac CT scan to detect the presence of thrombus in the left atrial appendage. If thrombus is absent, cardioversion can be performed and anticoagulation continued for a minimum of 4 weeks to allow time for recovery of atrial mechanical function.
Adequate rate control in AF is defined as ______
Adequate rate control in AF is defined as a resting heart rate of <80 beats/min that increases to <100 beats/min with light exer-tion, such as walking.
In CHADSVAC, Anticoagulation is currently recommended for patients with a score of at least 1, unless the lone risk factor is female gender
In CHADSVASC, Anticoagulation is currently recommended for patients with a score of at least 1, unless the lone risk factor is _________
Components of CHADSVASC and HASBLED
Examples of oral factor Xa inhibitor
Apixaban
Edoxaban
Rivaroxaban
Example of antithrombin inhibitor
Dabigatran
Example of vitamin K antagonist
Warfarin
Warfarin is warranted for anticoagulation in these 2 conditions
Rheumatic mitral stenosis
Mechanical heart valves
Required PT/INR ratio for warfarin to achieve therapeutic effect
> 2
Direct acting anticoagulants cannot be used if with crea clearance of ____
<15
This anticoagulant has safety and efficacy in px undergoing HD for ESRD
Apixaban
How to reverse:
Warfarin
Dabigatran
Xa inhibitors
WARFARIN: vitamin K, FFP, Prothrombin complex concentrate
Dabigatran: idarucizumab
Xa inhibitors: Andexanet alfa
Standard vs reduced dose of
Dabigatran, Rivaroxaban, Apixaban, Edoxaban
Dose reduction criteria for dabigatran vs rivaroxaban va apixaban vs edoxaban
Which can be used for px with structural heart disease… class I or class III antiarrhythmicsc
Class III: sotalol and dofetilide
Catheter ablation has a _____% risk of major procedure-related complications
Catheter ablation has a 2-7% risk of major procedure-related complications,
Percent risk of stroke vs cardiac tamponade in catheter ablatiom
Stroke: 0.5-1%
Cardiac tamponade: 1%
This complication of catheter ablatiom presents with dyspnea or hemoptysis occuring usually after weeks to months from the procedure
PV stenosis
Catheter ablation has the ff class recommendation….
1. Paroxysmal
2. Persistent AF without major risks for recurrence
3. HFREF
- Paroxysmal - Class IIa
- Persistent AF without major risks for recurrence - Class IIb
- HFREF - Class I
