EKG-Afib Flashcards
What are mainstay definitions of A.Fib?
Tachycardia, Irregular rhythm, no obvious p wave
What is the cause of A. Fib w/in the heart?
- Unorganised electrical impulse from pulmonary vein
What occurs in the wall of atrial that set off RAAS?
Dilation-stretch from pressure. L/2 LA contraction weak. Overall CO DEC by 20%
Mr. Show has palpitations, DOE, fatigue, Presyncope. PMH of OSA and obesity. What may show on his EKG?
A. Fib.
What is most common presentation w/ A. Fib
1/3 Asymptomatic
Who gets A. Fib?
- OSA 2. Obesity 3. CHF/HTN/Ischmic Heart Dz 4. Valve Dz 5. Caridac post op 6. Hyper thyroid 7. Genetic 8 Dehydration 9 Illness 10 Beinge ETOH
What is MC typ of A. Fib w/ 50% of cases. Releive iself w/in 7day often w/in 24 hours
Paroxymal AF
This type of A. Fib DOES NOT resolve on own,but is longer than 7d?
Persitent
Mr. Show with A. Fib states he has been feeling this way for years, palpitations, DOE, despite TX w/ meds?
Permannet AF
This is major risk with AF. Who get it?
Stroke- disablin, fatal, can reoccure. Caused by thrombus in LA appendage 1. CHF 3x 2. Dementia 2x 3. Women 100% death 4.
What are the primary goals for treatment of A. Fib?
- Prevent embolic strok w/ ANTICOAGULATION 2. Prevent cardiac damage via HEART RATE CONTROL
What score help determine who gets Anticoagulation meds for stroke risk?
Score >2 Oral anticoaguants Congenital HF HTN A2-AGe- 2pts* DM S2-stroke- 2pts* Vascular Age 65-74 Sex Category- Femal 1pt
What is score for benefits of anticoagulants and risk of bleeding?
3+- observe them carefully or too much risk HTN Abnormal liver or kidney Stroke Bleeding Labile INR Elderly >65 Drugs/Etoh
How many points are added if Pt has age >75 or PMH of stroke?
2- clinically MAJOR risk
Is reversal of Warfarin simple, if INR over 2-3?
DEC dosage by 10-15% recheck weekly.
Which RX are replacing Warfarin and Why?
Xa inhibitors -xaban.
IIa-Dabigatran.
NO blood testing food interaction,
LESS DI,
less bleeding
What are contraindications to AVOID w/ Xa and IIa?
- valve replacement
- severe mitral stenosis,
- Renal Dz
Which Xa drug has mortality benefit?
apixaban (Eliquis)
Which IIa drug is superior for CVA prevention?
Dabigatran- GIB high, Dyspepsia
What is easy to control for Afib… Rate or Rhythm?
Rate
Strict rate <80,
Lenient- <110 child, active, ASX w/ Normal LV systolic
How do rate controls work?
They dec ventricular rate only
What are the rate control RX?
- Beta blocker- olol,
- CCB- Dilitazem Verapiml,
- Digoxin- added effect.
- Pacemaker-last
When do we HAVE to attempt rhythm control?
- Unstable pt- LOC, INC BP, fever
2. If comorbities destabilize.- CHF, unstable angina
When should we consider Rhythm control?
- SX W/ AF despite good rate control
- Poor rate control
- Pt tachycardia mediated cardiomyopathy
- Active Pt
- Small LA-less chance for rate control
What is used for rhythm conversion through the esophagus?
Electrical Cardioversion w/ TEE-
view LAA
may not last-.70-90% eff.
What are the chemical cardioversion?
Amiodarone, Procainmide, Solotol- SE.
Which cardioversion therapy targets pulmonary veins, BUT is used last resort?
Radio-frequency and cryotherapy-tranvenous catheter ablation-
For Pt resistent to Meds,. 70-80% eff.
IF a patient in the clinic is DX w/ A.Fib but onset is unknown. What is the next step?
Patient must be anti-coagulated for 4wk B4 starting Rhythm Conversion.
IF ONSET IS KNOWN only 48hrs needed
What is the ideal agent that has high success for conversion, safe, BUT short term use d/t toxicity of liver, lung?
Amiodarone
For Rhythm control drugs, which can be added if rate not controlled?
Beta and Ca Blockers
Which med is both rate and rhythm control?
Beta Blockers
What is supra-ventricular tachycardia with regular rhythm in atria?
A. flutter
What are treatment benefits for A. Flutter?
- Rate control similar to AF
- Rhythm control early cardioversion. Drug don’t work
- Ablation 97% success
