Cardiology\ Atrial Fibrillation Flashcards
Types of AF
- Paroxysma AF
- Persistent AF
- Permanent AF
- Lone
Define - Paroxysmal AF
Episode of AF terminates spontaneously in less than 7 days
Define - Persistent AF
Episode fails to resolve within 7 days
Define - Permanent AF
Episode lasts for more than 1 year
Define - Lone AF
Paroxysmal, persistent, or permanent atrial fibrillation in patients without structural heart disease
What is the rhythm in atrial fibrillation?
Irregularly irregular
What diagnostic tests should be obtained in atrial fibrillation?
- ECG
- echocardiogram
- thyroid stimulating hormone (to evaluate for thyrotoxicosis)
What is the utility of echocardiogram in atrial fibrillation?
- Evaluate for structural heart disease
- patients with left atrial enlargement (>4 cm) are unlikely to remain in normal sinus rhythm if cardioverted
- transesophageal echocardiograms can evaluate for left atrial or left atrial appendage thrombi, suggesting that the patient does not need four weeks of warfarin and can be cardioverted
What are the management decisions in atrial fibrillation?
- Rate control with beta-blockers or calcium channel blockers versus rhythm control with electric or pharmacologic cardioversion
- anticoagulation to prevent emboli
What did the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) trial indicate?
The AFFIRM trial indicated that rhythm control does not decrease the rate of embolic events compared to rate control.
In the absence of anticoagulation, what percentage of patients with atrial fibrillation will have a stroke each year?
3%-5%
What score can be used to predict the annual risk of stroke in patients with atrial fibrillation?
CHADS2 score
How is the CHADS2 score calculated?
- Congestive heart failure (1 point)
- hypertension (1 point)
- age ≥75 (1 point)
- diabetes mellitus (1 point)
- prior stroke (2 points)
Which patients should receive anticoagulation with warfarin (INR target 2-3)?
Patients with CHADS2 scores of 2 or more
What is the treatment for patients with CHADS2 scores of 1?
Aspirin or warfarin
