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CRT > E.4 Atrial Fibrillation > Flashcards

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
Q

What scoring tool is used to estimate bleed risk in Afib patients on anticoagulants?

A

HASBLED Score

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26
Q

What does CHA(2)DS(2)VASC Score Stand For.

A

C: Congestive Heart Failure
H: Hypertension
A: Age >75
D: Diabetes Mellitus
S: Stroke
V: Vascular Disease
A: Age 65-74
Sc: Sex Category

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27
Q

Which Components of the CHADSVASc score are worth two points.

A

1) Age >75
2) Stroke History

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28
Q

What CHADSVASC score indicates anticoagulant treatment in atrial fibrillation.

A

2+ (men)
3+ (females)T

29
Q

The HASBLED score is only validated for _____

A

Warfarin.

30
Q

If patients have a CHADSVASc score greater than 2 (men) or 3 (females), _____ is recommended.

A

Oral Anticoagulation

31
Q

______ are recommended over warfarin in patients with Afib.

A

DOACs.

32
Q

When would warfarin be preferred over DOACs?

A

1) Moderate-Severe Mitral Stenosis
2) Mechanical Heart Valves.

33
Q

Patients with an elevated CHADSVASc score and ESRD or dialysis should reasonably be initiated on ____ or ____

A

1) Warfarin
2) Apixaban

34
Q

_____ is allowing patients to remain in atrial fibrillation but control the rate to control symptoms.

A

Rate Control

35
Q

_____ rate control should be used for patients who are
asymptomatic AND have an ejection fraction >40%.

A

Lenient (<110 bpm)

36
Q

____ rate control should be used for patients who are symptomatic or patients with EF <40%.

A

Strict rate Control (<80 BPM)

37
Q

What rate control agents are generally first line?

A

Beta Blockers, Diltiazem, Verapamil.

38
Q

What rate control agents are used first line for HFrEF?

A

1) Beta-blocker
2) Digoxin

39
Q

What rate control agent should be used second line?

A

Amiodarone

40
Q

Non-DHP CCB are ____ inhibitors. (think metabolism)

A

CYP3A4

41
Q

Digoxin is a _____ substrate.

A

P-glycoprotein

42
Q

What drugs increase digoxin concentrations.

A

Amiodarone, Dronedarone, Verapamil.

43
Q

What patients require conversion to sinus rhythm?

A
  1. Hemodynamically unstable
  2. Symptomatic Despite Rate Control
  3. Inability to achieve rate control.
44
Q

Two methods of cardioversion

A
  1. Chemical Cardioversion
  2. Direct Current Cardioversion. (DCCV)
45
Q

Flecainide Drug Class

A

Class 1C Antiarrhythmic

46
Q

Propafenone Drug Class

A

Class 1 C Antiarrhythmic.

47
Q

Sotalol Drug Class

A

Class III Antiarrhythmic

48
Q

What are the class II antiarrhythmics

A

Beta-Blockers

49
Q

Dofetilide Drug Class

A

Class III Antiarrythmic

50
Q

Amiodarone Drug Class

A

Class III Antiarrhythmic

51
Q

Dronedarone Drug Class

A

Class III Antiarrhythmic

52
Q

Ibutilide Drug Class

A

Class III Antiarrhythmic

53
Q

What are the class IV antiarrhythmics?

A

Non-DHP CCB. (Verapamil and Diltiazem)

54
Q

________ are membrane stabilizers.

A

Sodium Channel Blockers (Class I Antiarrhythmics.)

55
Q

_____ extend the refractory period.

A

Potassium Channel Blockers (Class III) Antiarrhythmic

56
Q

These antiarrhythmics effect depolarization _____.

A

Sodium Channel Blockers Class 1

57
Q

These antiarrhythmics widen the QRS complex.

A

Class I Antiarrhythmics

58
Q

These antiarrhythmics widen the QT interval.

A

Class III Antiarrhythmics

59
Q

Which Antiarrhythmics are preferred for an EF <40%

A

Amiodarone
Dofetilide
Ibutilide

60
Q

Flecainide Dose

A

50 mg BID (MDD=300 mg)

61
Q

Propafenone Dosing

A

IR = 150 mg Q8H
ER = 225 mg BID.

62
Q

Class IC Antiarrhythmics under go ____ metabolism.

A

CYP2D6

63
Q

At what CrCl is dofetilide contraindicated?

A

20

64
Q

Dofetilide dosing

A

500 mcg PO twice daily.

65
Q

Sotalol is contraindicated at a CrCl below _____

A

40

66
Q

Which antiarrhythmics require a 3 day hospital stay to monitor QT prolongation.

A

Sotalol and Dofetilide.

67
Q

Which Class III Antiarrhythmic is contraindicated in HF and permanent AF.

A

Dronedarone.

68
Q

Which Antiarrhythmics are first line in CAD?

A
  1. Dofetilide
  2. Dronedarone
  3. Sotalol.
69
Q

Which Antiarrhythmic is first line in heart failure?

A
  1. Amiodarone
  2. Dofetilide.

CRT (16 decks)

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