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)