Lecture 22: Dysrhythmias Part 2

Question 1

What characterizes an ectopic atrial arrhythmia?

Answer 1

• Ectopic focus creating an AP that is faster than the SA node, so it is now the pacemaker.
• Varied P wave morphology
• Rate between 50-180 (usually 100+)

Question 2

What kind of atrial tachycardia is MC in lung patients?

Answer 2

Multifocal

Question 3

How do we manage AT?

Answer 3

• BBs and non-DHP CCBs
• If refractory: Class 1C or Class III
• Ablation

Only for sustained and symptomatic

Question 4

How is Afib staged?

Answer 4

Question 5

What are the primary risk factors for AFib?

Answer 5

• CHF
• HTN
• Age
• CAD
• Valvular HD

Question 6

How can afib affect BP?

Answer 6

It can cause hypotension if there is underlying heart disease

Question 7

What are the more concerning aspects of afib?

Answer 7

• Tachycardia => cardiomyopathy
• Hypotension
• Development of thrombi

Question 8

What kind of rhythm is AFib?

Answer 8

Irregularly Irregular

Question 9

What are the 3 aspects of managing Afib?

Answer 9

1. Rate control
2. Rhythm control
3. Thromboembolic event prevention

Question 10

What are the 3 first-line options of rate control in AFib?

Answer 10

1. CCBs
2. BBs
3. Digoxin

You would decide based on clinical picture.
CCBs = avoid in HF
BBs = avoid in asthma/bronchospasms
Digoxin = avoid in kidney failure

Question 11

What is last resort managment for rate control in AFib?

Answer 11

AVN ablation with a PPM

Question 12

In a patient with AFib but no heart disease, what is the first-line options for rhythm control?

Answer 12

Class 1C or dronedarone/sotalol

Question 13

What is the main CI to using class 1C antiarrhythmics?

Answer 13

Structural heart disease

Question 14

Summary of rhythm control management in AFib

Answer 14

Question 15

For an elective cardioversion, what are the requirements?

Answer 15

• < 48 hrs in duration
• Lack of thrombus via TEE
• 3 weeks of uninterrupted AC prior to CV
• 4 weeks of uninterrupted AC post CV

Mechanical or ibutilide

Question 16

What is the CHADS2VASc score criteria?

Answer 16

• CHF: 1
• Hypertension (140/90): 1
• Age >= 75: 2
• DM: 1
• Stroke or TIA: 2
• Vascular disease: 1
• Age 65-74: 1
• Sex: 1 (if female)

Must know!!!!!!!

The first A and S are 2 pts

The later A and Sc are 1 pt

Question 17

For someone with AFib and a CHADS2VASc score of 1, what is the recommendation?

Answer 17

Oral AC or antiplatelet (asa 81mg)

Only exception is if the 1 point is due to being female. They are technically a 0.

Question 18

For someone with AFib and a CHADS2VASc score of 2, what is the recommendation?

Answer 18

Oral AC

Question 19

What is the criteria for determining specific AC need in someone with AFib?

Answer 19

HAS-BLED score

Do not need to know the full criteria

Question 20

What is the only AC used for valvular AFib?

Answer 20

Warfarin (vit K antagonist)

Question 21

If a patient presents to the ER with afib, what is the more probable first-line management in terms of AC?

Answer 21

• LWMH
• Heparin

Parenteral first, then switch to oral

Question 22

What are the Oral AC optiosn for Afib management?

Answer 22

• Warfarin (INR goal of 2-3)
• Dabigatran (BID, renal dosing)
• Rivaroxaban (QD, renal dosing)
• Apixaban (BID, renal dosing, age dosing, weight dosing)
• Edoxaban (QD, renal dosing)

Anything with Xaban is a 10a inhibitor (bans 10a)

Question 23

What common substance is cardiotoxic?

Answer 23

Alcohol

Question 24

What is the preferred management option for aflutter?

Answer 24

Catheter-based ablation followed by 4 weeks of AC

Everything else is the same as afib management.