Cardio- Atrial Fibrillation Flashcards
What is AFib?
- Rapid and irregular heartbeat
- Fatigue
- Dizziness
- Weakness
Name the 3 types of AFib?
- Paroxysmal (less 7 days)
- Persistent (greater than 7 days)
- Permanent (continuous AFib)
What medications controlled HR?
- Selective Beta-blockers (1st line)
- Calcium Channel Blockers (NON-DHP)
- Digoxin
What are target Digoxin concentrations?
AFib less than 1 ng/ml (greater in Afib)
CHF 0.5 to 0.8 ng/ml
What medications impact RHYTHM control?
- Potassium Channel Blockers (Amiodarone)
- Sodium Channel Blockers
(Flecainide: Tambocor)
(Propafenone: Rythmol)
Amiodarone Clinical Pearls (6)?
- Long half-life
- Liver toxicity
- Pulmonary toxicity
- Thyroid impact
- Drug Interactions
- QTc proglongation
When is anticoagulation required for AFib?
When CHADS2Vasc Score of 2 or greater
- CHF
- HTN
- Age 65-74 (+1)| 75 or greater (+2)
- DM
- Stroke (+2)
- Vascular Dx
Which anticoagulants are preferred in Afib?
NOACs
- dabigatran, rivaroxaban, apixiban, edoxaban
Class I recommendation
Which anticoagulants are preferred in Afib (dialysis patients)?
Warfarin or Apixaban
- Class 2b recommendations
Reversal agents for dabigatran?
Idarucizumab
- Class 1 recommendation
Reversal agents for Apixaban & Rivaroxaban?
- Andexanet Alfa
- Class 2 recommendation
- Boxed warning: Thromboembolic risks, ischemic risks, cardia arrest and sudden death
T/F: Cardioversion in new onset Afib can INCREASE risk of thrombus?
True
- anticoagulation should be initiated at least 3 weeks before and 4 weeks after cardioversion.
Medication Cardioversion Options? (review)
- Flecanide(Tambocor) - Class 1c
- Propafenone (Rythmol)- Class 1c
- Dofetilide (Tikosyn)- Class 3
- Ibutilide (Corvert)- Class 3
- Dronedarone (Multaq)
