EXAM #2: A-FIB

Question 1

What is the most common sustained arrhythmia in the US?

Answer 1

A-fib

Question 2

What causes A-fib?

Answer 2

1) LAE
2) IHD
3) Toxin i.e. alcohol
4) Metabolic disease
5) Hemodynamic impairment

Question 3

What happens to CO in a-fib?

Answer 3

Decreased CO b/c atrial-kick is lost

Question 4

What is paroxysmal a-fib?

Answer 4

Episodes of a-fib lasting between 1-7 days

Question 5

What is persistent a-fib?

Answer 5

Non-self limited a-fib that lasts longer than 7 days

Question 6

what is permanent a-fib?

Answer 6

A-fib for more than a year

*Cardioversion failed or not attempted

Question 7

What is lone a-fib?

Answer 7

A-fib with no overt cardiovascular pathology

*Note that these patients do NOT require therapy/anticoagulation

Question 8

How will the heart sounds change in a-fib?

Answer 8

Variable intensity of S1

Question 9

What is atrial smoke in a-fib?

Answer 9

Spontaneous echo contrast b/c of thrombus

Question 10

What etiology of a-fib is most commonly associated with CVA?

Answer 10

Nonvalvular

Question 11

What patients have an increased risk of CVA with a-fib?

Answer 11

1) Older than 65
2) HTN
3) Rheumatic Heart Disease
4) Prior TIA or CVA
5) DM
6) CHF

Question 12

What are the two approaches to treating a-fib?

Answer 12

Rhythm vs. rate control

Question 13

What are the hypothesized advantages of rhythm control in a-fib?

Answer 13

1) Improve sx.
2) Improve hemodynamics
3) Reduce CVA risk
4) Prevent need for anticoagulation

Question 14

What did the AFFIRM study show?

Answer 14

1) No difference in mortality between rhythm and rate control
2) Same stroke risk
3) Increased hospitalizations with rhythm control

Question 15

How should you treat an initial a-fib event?

Answer 15

1) Evaluate for underlying cause

2) Clinical status determine course

Question 16

How can you achieve rhythm control in a-fib?

Answer 16

1) DC cardioversion

2) Pharmacologic agents

Question 17

When is urgent DC cardioversion necessary?

Answer 17

1) MI
2) Evidence of shock
3) Severe HF sx.
4) Pre-excitation

Question 18

What is the currently preferred method for treatment of a-fib?

Answer 18

Rate-control

Question 19

When is rate control NOT the preferred method to treat a-fib?

Answer 19

1) Sx persist despite good HR

2) Unable to control HR

Question 20

When are antithrombics not indicated in a-fib?

Answer 20

1) Under 60 y/o

2) Lone a-fib

Question 21

What should you do for patients that cannot take warfarin?

Answer 21

ASA + clopidogrel