L16 - Atrial Fibrillation

Question 1

What is the disorganized atrial rhythm usually originating in the left atrium

Answer 1

Atrial fibrillation

Question 2

Electrical rate of A-fib

Answer 2

350+/min

Question 3

How is atrial flutter different than A-fib?

Answer 3

Atrial flutter is organized vs A-fib disorganized rhythm

A flutter orig in RA vs A-fib in LA

Question 4

What is the rhythm originating from a single focus or small circuit in either atrium at rates over 100/min

Answer 4

Atrial tachycardia

Question 5

What type of AF is this?

• Terminates spontaneously in less than 7 days

Answer 5

Paroxysmal AF

Question 6

What type of AF is this?
• Won’t terminate without intervention
○ Drugs, Cardioversion

Answer 6

Persistent AF

Question 7

What type of AF is this?

Has existed for months or years – but there is still hope!

Answer 7

• Long-standing Persistent AF

Question 8

What type of AF is this?

• No hope – or at least no one is considering trying to fix it

Answer 8

Permanent AF

Question 9

Where does Afib start? and how?

Answer 9

Pulmonary veins - there are electrically active fibers from the atria that extend from the atria to the pulm veins

Question 10

Who gets Afib?

Answer 10

More common with white males with increasing age and those with diabetes, HTN, valve disease

Question 11

Which is false regarding AF?
A. Most common heart rhythm problem
B. Increases your risk of dying
C. Decreases risk of stroke
D. Poor quality of life

Answer 11

C. Increases

Question 12

What are 3 concerns when you see a patient in AF

Answer 12

1. Symptoms: none, palpitations, chest pain, dyspnea, fatigue, exercise intolerance, dizziness and syncope
2. What is their risk of stroke
3. Long-term injury: can get tachycardia mediated cardiomyopathy

Question 13

What are options available to manage AF if :
severe symptoms
not severe symptoms

Answer 13

1. urgent cardioversion - may need screening transesophageal echo to rule out LA thrombus
2. control HR and begin anticoag as approp. Can cardiovert if been on anticoag for 3 weeks w/o transesophageal echo

Question 14

How do you work-up a patient with AF?

Answer 14

1. Echo (LA size, LV function, valve disease)
2. 24-48 hour monitor HR
3. thyroid studies
4. Routine labs (CBC, BMP, Mg++)

Question 15

What are the components of the CHADS2-VASc Score and what does it assess?

Answer 15

C = CHF
H = HTN (>140/90mmHg)
A = >75yo
D = DM
S2 = Prior TIA or stroke
V = Vascular disease (MI, aortic plaque, etc)
A = Age 65-74
Sc = sex category (female = 1pt)

Risk score for AF. If 2 or greater than give anticoag stronger than aspirin

Question 16

What is false regarding the options for managing AF
A. Anticoagulation and rate control - with older patients without symptoms
B. Rhythm control drugs and cardioversion - 100% effective
C. Pacemaker +/- AV nodal ablation
D. Catheter ablation to cure AF
E. Surgery to cure AF

Answer 16

B. 50% effective