EXAM #2: A-FIB Flashcards
What is the most common sustained arrhythmia in the US?
A-fib
What causes A-fib?
1) LAE
2) IHD
3) Toxin i.e. alcohol
4) Metabolic disease
5) Hemodynamic impairment
What happens to CO in a-fib?
Decreased CO b/c atrial-kick is lost
What is paroxysmal a-fib?
Episodes of a-fib lasting between 1-7 days
What is persistent a-fib?
Non-self limited a-fib that lasts longer than 7 days
what is permanent a-fib?
A-fib for more than a year
*Cardioversion failed or not attempted
What is lone a-fib?
A-fib with no overt cardiovascular pathology
*Note that these patients do NOT require therapy/anticoagulation
How will the heart sounds change in a-fib?
Variable intensity of S1
What is atrial smoke in a-fib?
Spontaneous echo contrast b/c of thrombus
What etiology of a-fib is most commonly associated with CVA?
Nonvalvular
What patients have an increased risk of CVA with a-fib?
1) Older than 65
2) HTN
3) Rheumatic Heart Disease
4) Prior TIA or CVA
5) DM
6) CHF
What are the two approaches to treating a-fib?
Rhythm vs. rate control
What are the hypothesized advantages of rhythm control in a-fib?
1) Improve sx.
2) Improve hemodynamics
3) Reduce CVA risk
4) Prevent need for anticoagulation
What did the AFFIRM study show?
1) No difference in mortality between rhythm and rate control
2) Same stroke risk
3) Increased hospitalizations with rhythm control
How should you treat an initial a-fib event?
1) Evaluate for underlying cause
2) Clinical status determine course
How can you achieve rhythm control in a-fib?
1) DC cardioversion
2) Pharmacologic agents
When is urgent DC cardioversion necessary?
1) MI
2) Evidence of shock
3) Severe HF sx.
4) Pre-excitation
What is the currently preferred method for treatment of a-fib?
Rate-control
When is rate control NOT the preferred method to treat a-fib?
1) Sx persist despite good HR
2) Unable to control HR
When are antithrombics not indicated in a-fib?
1) Under 60 y/o
2) Lone a-fib
What should you do for patients that cannot take warfarin?
ASA + clopidogrel
