Rate & Rhythm Disorders

Question 1

What is A Fib?

Answer 1

Atrial activity that is poorly defined; ventricular response is irregularly irregular

Question 2

Symptoms of AFib

Answer 2

Palpitations, dyspnea, fatigue, angina

Question 3

Treatment for AFib

Answer 3

Electrical or pharmacological cardioversion

Question 4

What risk is associated with cardioversion in pt with hx of A Fib for more than 2 days?

Answer 4

Thromboembolism

To avoid use heparin 3 weeks before cardioversion and for 4 weeks after

Question 5

Indications for cardioversion

Answer 5

Recent onset of AF
No structural disease
Successful tx of precipitation causes of AF
Age
Acute FF, hypotension, acute heart failure, acute MI, unstable angina

Question 6

Anticoagulation for cardioversion

Answer 6

INR >2.5 3-4 wks before
or
INR > 2.5 at time of cardioversion & 3-4 weeks after

Question 7

Rhythm Control procedures for AF

Answer 7

Electrophysiology & pathway ablation

Left atrial appendage ligation

Question 8

Rate control for AF

Answer 8

Ventricular rate is one of the main causes of symptoms.

Goal is to keep rate less than 90 at rest and 180 with exercise

Question 9

Drugs for rate control in AF

Answer 9

BB (decrease exercise tolerance; 1st line esp HTN & angina)
CCB (no affect on exercise; 1st line esp HTN & angins)
Digoxin

Question 10

What can be used for refractory cases of AF

Answer 10

Amiodarone

Question 11

What should be considered for pt with unsuccessful medication treatment?

Answer 11

Ablation of AV node and pacemaker implantation

Question 12

CHADS2 Scoring for risk stroke

Answer 12

3 or higher is high risk