Cardiology - Atrial Fibrillation Flashcards
Classifications of AFib?
#first-detected #paroxysmal #persistent (over 7 days) #long-standing persistent (over 1 year)
3 early tests in pt with new Afib?
#TSH #Sleep apnea testing (if suggestive history) #ECHO for valvular/structural heart disease
Pt with new afib - decision made not to cardiovert - does the patient need IV anticoagulation?
#no IV AC needed (begin ORAL AC) #
Pt with new afib - decision made to cardiovert - need for anticoagulation if? How long to wait to cardiovert? Can cardiovert sooner if? How long to keep on AC if cardioversion successful?
Afib for more than 48 hours (or unclear duration)
3 weeks on AC; TTE negative for thrombus
4 weeks minimum
Indication for immediate cardioversion regardless of how long pt has been in Afib?
Afib with #hypotension #myocardial ischemia #heart failure
Acute cardioversion of atrial fibrillation should be synchronized to what? (why?)
R wave (avoid an “R-on-T” event and provocation of VF)
Goal HR range in rate controlled afib?
60-110
Acute IV drugs for rate control in symptomatic afib with RVR?
#metoprolol #esmolol #diltiazem #verapamil
Avoid calcium channel blockers in afib patients if?
LV dysfunction
Digoxin especially good for rate control in patients with?
heart failure
Treatment for preexcitated atrial fibrillation?
procainamide
Pharmacologic cardioversion options for afib? (class and specific drugs)
Class IC agents (flecainide, propafenone)
Ibutilide (Class III)
When use CHA(2)DS2-VASc?
Score that warrants AC?
CHADS2 score of 0 or 1
2+
Conditions that require anticoagulation regardless of CHADS2(-VASc) score?
#mitral stenosis #rheumatic heart disease #prior systemic embolism #prosthetic heart valve #left atrial appendage thrombus #hypertrophic cardiomyopathy
When to give warfarin instead of considering novel anticoagulants?
Valvular afib (defined as afib with mitral stentosis or mitral valve replacement)
Bleeding risk of dabigatran (vs warfarin)?
#decreased stroke risk #decreased intracranial bleeding #higher risk of GI bleeding
Bleeding risk of rivaroxaban (vs warfarin)?
#decreased intracrainal/fatal bleeding #higher risk of GI bleeding
Bleeding risk of apixaban (vs warfarin)?
#Decreased stroke risk #decreased intracrainal bleeding #Similar GI bleeding risks
All novel anticoagulants are cleared by?
kidney
treatment of patient with Afib and recent ACS?
If patient has stent placed?
low dose aspirin and anticoagulation
triple therapy with thienopyridine (plavix) for as short of a time as possible (6 months if DES)
Cormorbidities in a patient with afib that needs more stringent rate control (HR 60-80 at rest)?
#tachycardia-induced cardiomyopathy #heart failure #LVEF under 40%
In addition to rate control at rest, afib patients should also undergo? (options?)
Assessment of HR with activity
#ambulatory ECG monitoring #stress test #6-minute walk test.
Patient who may benefit from pill-in-the-pocket approach?
#infrequent symptomatic afib #no structural heart disease or conduction disease #already taking AV nodal blocker
patients who have refractory symptomatic atrial fibrillation despite antiarrhythmic drug therapy may benefit from? Reserve for which patients?
Cather ablation with pulmonary vein isolation
#early afib #no LA enlargment
Patient develops dyspnea months to years after afib ablation - consider?
pulmonary vein stenosis
In patients with symptomatic atrial fibrillation who are undergoing cardiac surgery for other reasons, can qualify for this procedure?
Maze procedure
Patients with refractory symptomatic tachycardia despite attempts at rate and rhythm control may be candidates for?
If done, pt will need? Will they need to remain on anticoagulation?
AV node ablation
pacemaker; yes
