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CDM 2 Exam 1 > Lecture 8 - Afib > Flashcards

Lecture 8 - Afib Flashcards

1
Q

Atrial Fibrillation info

A

Supraventricular tachyarrhythmia

Uncoordinated atrial activation**

irregularly, irregular pulse

ineffective atrial contraction

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2
Q

Atrial flutter info

A

Supraventricular tachyarrhythmia

Regular atrial activation***

Variable rapid pulse

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3
Q

where does AFib come from?

A

Atrial Structure abnormalities

Atrial Electrical abnormalities

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4
Q

A-Fib risk factors

A 
Hypertension
Obesity
Sleep apnea
Hyperthyroidism
Alcohol + Drugs

Anything changing structure of heart

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5
Q

Non-cardiac Etiology for A-Fib

A 
Genetic/Family history
Social - Drinking, smoking
Endocrine 
Surgery (post-op)
Exercise
Medications
idiopathic = "lone AFib"
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6
Q

Meds that can increase AFib

A 
Theophylline
Adenosine
Digoxin
Bisphosphonates
NSAIDs
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7
Q

Acute A-Fib

A

< 48hrs

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8
Q

Paroxysmal A-Fib

A

< 7 days

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9
Q

Persistent A-Fib

A

> 7 days

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10
Q

Long-standing persistent A-Fib

A

> 1 year

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11
Q

5 Step approach to treatment of AF?

A
  1. is pt stable or unstable?
  2. How long have they been in AF
  3. Does the pt need rate control
  4. Does the pt need rhythm control
  5. Do we need anticoag
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12
Q

Ventricular rate control strategy shown to…

A

impact quality of life

reduce morbidity

decrease complications

rate control mostly for people who are stable

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13
Q

Heart rate targets for Ventricular rate control?

A

Resting < 80 bpm

Moderate exercise < 110 bpm

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14
Q

Using Beta-Blockers in Ventricular Rate control

A
  1. rapidly controls HR at rest and during exercise
  2. ** Avoid use in acute decompensated HF **
  3. Titration necessary o avoid bradycardia
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15
Q

Using Beta-Blockers in Ventricular Rate control (Acute, IV)

A

Metoprolol
Propranolol
Esmolol

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16
Q

Using Beta-Blockers in Ventricular Rate control (Chronic, PO)

A 
Atenolol
Metoprolol
Timolol
Pindolol
Nadolol
Labetalol
Bisoprolol
Carvedilol
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17
Q

Non-DHP CCB for Ventricular Rate control

A

Controls HR at rest and during exercise

** Avoid in acute decompensated HF or HFrEF (LVEF < 40%)

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18
Q

Non-DHP CCB for Ventricular Rate control drugs

A

Diltiazem
Verapamil

IV or PO for acute

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19
Q

Digoxin for Ventricular Rate control MOA

A

Vagotonic actions result in Ca current inhibition in AV node

Activation of acetylcholine-mediated potassium currents in atrium

*Lengthens refractoriness, decreases impulse conduction

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20
Q

Digoxin for Ventricular Rate control Considerations

A

Not 1st line, commonly used tho
Reduces HR during rest, ineffective during activity
Can be used in combo with BB or CCB
Maybe useful in HFrEF

21
Q

Digoxin for Ventricular Rate control Therapeutic Drug Monitoring

A

Goal: 0.8-2 ng/ml

Conc >1.2 associated with inc mortality

22
Q

Amiodarone for Ventricular Rate control MOA

A

Sympatholytic and CB properties slow AV node conduction

Prolongs repolarization, lengthens refractoriness, inhibits automaticity

23
Q

Amiodarone for Ventricular Rate control useful in…

A

refractory or with CI to other agents

OK in acute decompensated HF
Less effective than non-DHP CCB
similar efficacy to digoxin for use in persistent AF

24
Q

Amiodarone for Ventricular Rate control drawbacks

A

reg high dose load regimen to accelerate onset of action

toxicities and drug interactions limit use

25
Q

Which drugs should not be used with Wolff-Parkinson White Syndrome

A

BB
Non-DHP CCB
Digoxin
Amiodarone

26
Q

If rate control necessary, with an accessory pathway treat with….

A

Cardioversion or ablation

27
Q

If rate control necessary, with a preserved EF, treat with…

A

Start with BB or non-DHP CCB

use combo BB+non-DHP CCB + amiodarone for further rate control

Consider cardioversion or ablation if those don’t work

28
Q

If rate control necessary, with a reduced EF w/o decomposition, treat with…

A

Start with BB or digoxin

use combo BB + digoxin + amiodarone for further rate control

Consider cardioversion or ablation if those don’t work

29
Q

If rate control necessary, with a reduced EF w/ decomposition, treat with…

A

digoxin or amiodarone

use combo digoxin and amiodarone for further rate control

Consider cardioversion or ablation if those don’t work

30
Q

Indications for Rhythm Control

A
  1. Hemodynamic Instability
  2. First episode of AF
  3. Failure of rate control
  4. Younger pts ( < 65yr old)
  5. Pts early in their natural history
  6. Patient preference
31
Q

Rate vs Rhythm control

A

If rhythm selected, rate control also necessary to prevent recurrence of AF

  1. Rate control simpler + lower cost, but structural/electrical remodeling continues
  2. Rhythm control is associated with more SE
32
Q

Rhythm Control Pharmacologic treatment

A

Type I and Type III antiarrhythmics

33
Q

Rhythm Control Electrical option

A

Cardioversion + Ablation

34
Q

Antiarrhythmics are not recommended for routine use after….

A

cardioversion in pts with their first presentations of AF

35
Q

Class 1 Antiarrhythmics

A

Quinidine (A)
Disopyramide
Procainamide

Flecainide (C)
Propafenone

36
Q

Propafenone info

A

Has B-blocking properties

37
Q

Propafenone & Flecainide info

A

Class 1 rec
Most effective if AF < 7 days
“Pill-in-pocket” therapy

38
Q

Cautions of Class 1C (Flecainide & Propafenone)

A

Avoid in pts with CV disease

Multiple DI

may increase risk of embolism

39
Q

Dofetilide & Ibutilide info

A

Class 1 rec
OK in pt with CV disease
Ibutilide is IV only

40
Q

Class 3 Antiarrhythmics

A

Dofetilide
Ibutilide
Sotalol
Amiodarone

41
Q

Dofetilide & Ibutilide Cautions

A

QTc prolongation

Dose adjustment in renal impairment

42
Q

Sotalol Cautions

A

Avoid in HF
Renal elim
Needs a lot of monitoring

43
Q

Amiodarone Cautions

A

DI
SE
Long 1/2 life

44
Q

Rhythm Control W/ CV disease acute

A

Dofetilide
Ibutilide
Amiodarone
DCC

45
Q

Rhythm control W/o CV disease acute

A 
Dofetilide
flecainide
Propafenone
Ibutilide
Amiodarone
DCC
46
Q

Big issue with Dronedarone?

A

CI in pt with HF or recent decomposition

47
Q

Rhythm control Maintenance, No Structural Heart Disease

A 
Dofetilides
Dronedarone
Flecainide
Propafenones
Sotalol

Amiodarone = last option

48
Q

Rhythm control Maintenance, CAD

A

Dofetilide
Dronedarone
Sotalol

Amiodarone = last option

49
Q

Rhythm control, Maintenance HF

A

Amiodarone or Dofetilides

CDM 2 Exam 1 (12 decks)

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