Module 4: part 5 - A Fib Flashcards
What are arrhythmias?
Abn electrical conduction in the heart
What do arrhythmias effect?
The normal HR and cardiac rhythm
What conditions are associated w arrhythmias
CAD, MI, HTN, valve dysfx, digoxin toxicity, low K+, CHF, CVA, pulmonary disease etc
At what rate do we begin to be concerned about abn HR?
less than 50 or greater than 100
What rate is the normal sinus rhythm?
~ 75 bpm
What is the HR during A Fib?
~ 150-300 bpm
Risk factors for developing A Fib?
There are a LOT, just know at least 5
- Advanced age with valvular heart disease (mitral/tricuspid)
- HTN
- Inflammatory or infiltrative disease
- CAD
- Congenital disorder
- HF
- Diabetes
- Obesity
- Hyperthyroidism
- Pulmonary Hypertension
- Embolism
- Obstructive sleep apnea (OSA)
- Moderate to heavy ETOH
- Following open heart Sx
What is the A Fib triad?
- Racing heart/fluttering/palpitations
- SOB
- Feeling lightheaded
Other S+S of A Fib:
- Irregular pulse
- Dizzy
- Weakness
- Fainting
- Decreased BP if not compensating
Which organ systems should you keep an eye on if pt has A Fib?
Hepatic and renal
Which ‘lytes should you keep and eye on if your pt has A Fib?
K, Na, Ca
Why is there an inc risk for thrombosis in pts w AFib?
Because if the atria are not pump properly, the blood can pool and form a clot
Dx tools for AFib?
- ECG
- Holter monitor
What is a Holter monitor?
Records heart activity for 24 hours
a portable ECG
What lab test should you run for Dx AFib?
- Platelets
- PTT
- PT-INR
- Digoxin level
- Electrolyte
How does defibrillation help w AFib?
It extinguishes all electrical activity, allowing the normal sinus rhythm to restart and take over again
How does cardioversion help w AFib?
Restores normal sinus rhythm by sending electrical shocks to the heart through electrodes placed on the chest
What is the difference between defibrillation and cardioversion?
- Cardioversion is a shock that is synchronized to the QRS complex
- Defibrillation is a shock delivered randomly
Why should cardioversion be done within the first 48 hours of onset of AFib?
Because there is a high risk for clotting after 48 hours and cardioversion started after 48 hours runs a high risk of dislodging the possible clots
What s the Maze procedure and how does this help restore a normal sinus rhythm?
Using surgical ablation, this is the creation of lines of scar tissue that block the abnormal impulses causing AFib. No AFib = normal sinus rhythm
3 drug classes you should give during AFib?
1) Beta-blockers
- eg metoprolol
2) Anti-arrhythmics
- eg Digoxin, Amiodarone
3) Anticoags
- Warfarin, Heparin, Apixban, Dalteparin
What is the effect of anti-arrhythmic drugs?
- Alter electrophysiological properties of the heart
- Slows the progression or conduction of electrical activity.
5 reasons why a pt may be on anticoags?
- Immobility (post surgical)
- Hx DVT/pulmonary embolus
- Dysrhythmias (AFib)
- Mechanical heart valve
- Post MI or CVA
T or F:
Anticoags dec clotting time to prevent thrombi from forming or growing larger
F, they inc clotting time to do this
What route(s) is/are Heparin given?
IV or subQ
What is the half-life of Hep?
90 min
What is thrombocytopenia, and what kind of effect does Hep have on it?
Thrombocytopenia is a low platelet count, Hep increases the risk of this
What is the antidote to Hep?
Protamine sulfate
How are LMWHs different from Heparin?
They provide a more stable response and their duration is 2-4 times longer than Hep, usually just one subQ injection daily, and a decreased risk for thrombocytopenia
what route(s) is/are Warfarin given?
Only PO
How long does Warf take to reach a therapeutic level?
3-5 days
What is the half life of Warf?
1-3 days
What lab(s) should you be monitoring for Warf?
PT-INR (Because this is for extrinsic pathway)
What is the antidote for Warf?
Vit K
What do anti-platelat drugs interfere with?
Platelet aggregation
Common Anti-platelets?
- ASA
- Clopidogrel
How long can anticoag effects of ASA last after a dose?
Up to a week
How long can anticoag effects of Clopid last after a dose?
Up to 5 days
Who is Clopid usually reserved for?
Pts who cannot tolerate ASA
After what sort of incident is Clopid given?
After recent MI or CVA
What organ systems should you be monitoring is you pt is on anticoags?
Hepatic and renal
What is the most important thing to monitor for when you pt is on anticoags?
Bleeding
eg hematuria, epistaxis, bloody stools, bruising
What is a consideration regarding IM injections when you pt is on anticoags?
Try to avoid/limit them
