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E.4 Atrial Fibrillation Flashcards

1
Q

____ is the most common arrythmia.

A

Atrial Fibrillation

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2
Q

Atrial Fibrillation is most common in those above _____

A

80 years old.

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3
Q

What are the primary two causes of atrial fibrillation.

A

1) Scarring or Fibrotic Tissue
2) Changes to cardiac action potential (electrolyte abnormalities, drugs)

Genetic Diseases are also a factor

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4
Q

Atrial fibrillation is often described as disorganized and irregular atrial electrical activity. This presents as a “quivering” on an ECG. In this case there is no distinguishable atrial depolarization/contraction corresponding to ____ waves.

A

P-waves.

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5
Q

Atrial fibrillation occurs when atrial tissue is ____

A

modified due to abnormalities in structure or function.

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6
Q

Atrial rate in Afib

A

600-800 bpm

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7
Q

Ventricular Rate in Afib

A

100-180 bpm.

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8
Q

Afib is triggered by rapidly firing ____ in the atria.

A

Ectopic Beats

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9
Q

Atrial fibrillation which terminates within 7 days of onset.

A

Paroxysmal

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10
Q

Atrial fibrillation which lasts longer than 7 days.

A

Persistent

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11
Q

Atrial fibrillation lasting longer than 12 months.

A

Longstanding, persistent.

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12
Q

Atrial fibrillation where the patient and clinician have decided that there will be no more effort to restore or maintain sinus rhythm.

A

Permanent

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13
Q

List some of the clinical manifestations of Afib.

A
  1. Fatigue
  2. Palpitations
  3. Shortness of Breath
  4. Hypotension
  5. Dizziness, Light-headedness
  6. Syncope
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14
Q

T or F: Many Afib patients are asymptomatic.

A

True.

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15
Q

What is AFib with Rapid Ventricular Rate (RVR)

A

An acute presentation of Afib where the patient has a higher HR due to more conduction through the AV node. This leads to ventricular tachycardia.

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16
Q

Afib increases the risk of stroke by ____

A

5 Fold

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17
Q

Afib increases the risk of heart failure by ____

A

3 fold

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18
Q

Afib increases the risk of dementia by ____

A

2 fold

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19
Q

Afib increases the risk of hospitalization by ____

A

2 fold

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20
Q

Afib increases the risk of mortality by ____

A

2 fold

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21
Q

What are the 3 forms of treatment for Atrial Fibrillation.

A
  1. Anticoagulation
  2. Rate Control
  3. Rhythm Control.
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22
Q

T or F: Strokes which occur in patients with Afib are less detrimental to QOL than patients who do not have Afib.

A

F

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23
Q

In atrial fibrillation, clots are able to form in the ____ due to pooling of blood.

A

Left Atrial Appendage

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24
Q

What scoring tool is used to estimate stroke risk in Afib patients.

A

CHA2DS2VASc Score

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25
What scoring tool is used to estimate bleed risk in Afib patients on anticoagulants?
HASBLED Score
26
What does CHA(2)DS(2)VASC Score Stand For.
C: Congestive Heart Failure H: Hypertension A: Age >75 D: Diabetes Mellitus S: Stroke V: Vascular Disease A: Age 65-74 Sc: Sex Category
27
Which Components of the CHADSVASc score are worth two points.
1) Age >75 2) Stroke History
28
What CHADSVASC score indicates anticoagulant treatment in atrial fibrillation.
2+ (men) 3+ (females)T
29
The HASBLED score is only validated for _____
Warfarin.
30
If patients have a CHADSVASc score greater than 2 (men) or 3 (females), _____ is recommended.
Oral Anticoagulation
31
______ are recommended over warfarin in patients with Afib.
DOACs.
32
When would warfarin be preferred over DOACs?
1) Moderate-Severe Mitral Stenosis 2) Mechanical Heart Valves.
33
Patients with an elevated CHADSVASc score and ESRD or dialysis should reasonably be initiated on ____ or ____
1) Warfarin 2) Apixaban
34
_____ is allowing patients to remain in atrial fibrillation but control the rate to control symptoms.
Rate Control
35
_____ rate control should be used for patients who are asymptomatic AND have an ejection fraction >40%.
Lenient (<110 bpm)
36
____ rate control should be used for patients who are symptomatic or patients with EF <40%.
Strict rate Control (<80 BPM)
37
What rate control agents are generally first line?
Beta Blockers, Diltiazem, Verapamil.
38
What rate control agents are used first line for HFrEF?
1) Beta-blocker 2) Digoxin
39
What rate control agent should be used second line?
Amiodarone
40
Non-DHP CCB are ____ inhibitors. (think metabolism)
CYP3A4
41
Digoxin is a _____ substrate.
P-glycoprotein
42
What drugs increase digoxin concentrations.
Amiodarone, Dronedarone, Verapamil.
43
What patients require conversion to sinus rhythm?
1. Hemodynamically unstable 2. Symptomatic Despite Rate Control 3. Inability to achieve rate control.
44
Two methods of cardioversion
1. Chemical Cardioversion 2. Direct Current Cardioversion. (DCCV)
45
Flecainide Drug Class
Class 1C Antiarrhythmic
46
Propafenone Drug Class
Class 1 C Antiarrhythmic.
47
Sotalol Drug Class
Class III Antiarrhythmic
48
What are the class II antiarrhythmics
Beta-Blockers
49
Dofetilide Drug Class
Class III Antiarrythmic
50
Amiodarone Drug Class
Class III Antiarrhythmic
51
Dronedarone Drug Class
Class III Antiarrhythmic
52
Ibutilide Drug Class
Class III Antiarrhythmic
53
What are the class IV antiarrhythmics?
Non-DHP CCB. (Verapamil and Diltiazem)
54
________ are membrane stabilizers.
Sodium Channel Blockers (Class I Antiarrhythmics.)
55
_____ extend the refractory period.
Potassium Channel Blockers (Class III) Antiarrhythmic
56
These antiarrhythmics effect depolarization _____.
Sodium Channel Blockers Class 1
57
These antiarrhythmics widen the QRS complex.
Class I Antiarrhythmics
58
These antiarrhythmics widen the QT interval.
Class III Antiarrhythmics
59
Which Antiarrhythmics are preferred for an EF <40%
Amiodarone Dofetilide Ibutilide
60
Flecainide Dose
50 mg BID (MDD=300 mg)
61
Propafenone Dosing
IR = 150 mg Q8H ER = 225 mg BID.
62
Class IC Antiarrhythmics under go ____ metabolism.
CYP2D6
63
At what CrCl is dofetilide contraindicated?
20
64
Dofetilide dosing
500 mcg PO twice daily.
65
Sotalol is contraindicated at a CrCl below _____
40
66
Which antiarrhythmics require a 3 day hospital stay to monitor QT prolongation.
Sotalol and Dofetilide.
67
Which Class III Antiarrhythmic is contraindicated in HF and permanent AF.
Dronedarone.
68
Which Antiarrhythmics are first line in CAD?
1. Dofetilide 2. Dronedarone 3. Sotalol.
69
Which Antiarrhythmic is first line in heart failure?
1. Amiodarone 2. Dofetilide.

CRT (16 decks)

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