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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
Which drugs should not be used with Wolff-Parkinson White Syndrome
BB Non-DHP CCB Digoxin Amiodarone
26
If rate control necessary, with an accessory pathway treat with....
Cardioversion or ablation
27
If rate control necessary, with a preserved EF, treat with...
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
If rate control necessary, with a reduced EF w/o decomposition, treat with...
Start with BB or digoxin use combo BB + digoxin + amiodarone for further rate control Consider cardioversion or ablation if those don't work
29
If rate control necessary, with a reduced EF w/ decomposition, treat with...
digoxin or amiodarone use combo digoxin and amiodarone for further rate control Consider cardioversion or ablation if those don't work
30
Indications for Rhythm Control
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
Rate vs Rhythm control
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
Rhythm Control Pharmacologic treatment
Type I and Type III antiarrhythmics
33
Rhythm Control Electrical option
Cardioversion + Ablation
34
Antiarrhythmics are not recommended for routine use after....
cardioversion in pts with their first presentations of AF
35
Class 1 Antiarrhythmics
Quinidine (A) Disopyramide Procainamide Flecainide (C) Propafenone
36
Propafenone info
Has B-blocking properties
37
Propafenone & Flecainide info
Class 1 rec Most effective if AF < 7 days "Pill-in-pocket" therapy
38
Cautions of Class 1C (Flecainide & Propafenone)
Avoid in pts with CV disease Multiple DI may increase risk of embolism
39
Dofetilide & Ibutilide info
Class 1 rec OK in pt with CV disease Ibutilide is IV only
40
Class 3 Antiarrhythmics
Dofetilide Ibutilide Sotalol Amiodarone
41
Dofetilide & Ibutilide Cautions
QTc prolongation Dose adjustment in renal impairment
42
Sotalol Cautions
Avoid in HF Renal elim Needs a lot of monitoring
43
Amiodarone Cautions
DI SE Long 1/2 life
44
Rhythm Control W/ CV disease acute
Dofetilide Ibutilide Amiodarone DCC
45
Rhythm control W/o CV disease acute
``` Dofetilide flecainide Propafenone Ibutilide Amiodarone DCC ```
46
Big issue with Dronedarone?
CI in pt with HF or recent decomposition
47
Rhythm control Maintenance, No Structural Heart Disease
``` Dofetilides Dronedarone Flecainide Propafenones Sotalol ``` Amiodarone = last option
48
Rhythm control Maintenance, CAD
Dofetilide Dronedarone Sotalol Amiodarone = last option
49
Rhythm control, Maintenance HF
Amiodarone or Dofetilides

CDM 2 Exam 1 (12 decks)

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