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Cardio Final > Treatment of Afib > Flashcards

Treatment of Afib Flashcards

1
Q

Define Atrial Fibrillation

A

A suprventricular tachycardia with irregular, irregular rhythm
Atria contract at 400-600

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2
Q

Why is it just Afib?

A

Bc the AV node prevent most impulse from reaching the ventricles (120-180 BPM)

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3
Q

Define Rapid ventricular response (RVR)

A

Ventricular hear rate > 100 BPM

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4
Q

Define Paroxysmal AF

A

Revers to sinus rhythm automatically or with therapy within 7 days of onset

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5
Q

Define Persistent AF

A

Continuous AF that is > 7 days in duration

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6
Q

Define Permanent AF

A

When the patient and physician have decided to cease further attempts at maintenance of sinus rhthm

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7
Q

Complications of Afib

A

Stroke (CHADVASc)

Cardiomyopathy (long term consequence of rapid ventricular response)

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8
Q

*****EMERGENCY SYMPTOMS

A

MI or angina, flash pulmonary edema with hypoxia
HR >150 BP Less than 90/60

IMMEDIATELY CARDIOVERT

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9
Q

Causes of Atrial Distension

A 
Ischemia/MI
Pulmonary embolism, pneumonia, COPD/asthma, HF exacerbation
Chronic HTN
Valvular disease
Cardiomyopathy
Pulmonary HTN
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10
Q

Causes of high adrenergic tone

A 
Hyperthyroidism
Drug use: EtOH withdrawal, binge drinking, cocaine, amphetamines
Caffiene
Ephedrine
Sepsis
Beta agonists (inotropes)
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11
Q

Causes of Afib via surgery

A

CABG

Valve replacement or repair

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12
Q

Anticoagulation in Afib

A

CHADSVASC score for assessment of CVA risk and need for anticoagulation

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13
Q

Rhythm control =

A

Cardioversion
Cardiovert
“return the heart to normal sinus rhythm”

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14
Q

Rate Control

A

Leave in AF and rate control to prevent symptoms and complications

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15
Q

Rhythm Control

A

Convert patient from AF to sinus rhythm

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16
Q

IV Anticoagulate use in Acute AF

A

Should be started in those undergoing cardioversion due to risk of disloding thrombi and causing a stroke

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17
Q

Duration less than 48 hours Treatment

A

UFH and Cardiovert

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18
Q

Duration >48 hours

A

Anticoagulate for 3 weeks and then use a TEE to rule out a thrombi before proceeding to cardioversion

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19
Q

CHA2DS2VASc Score

A 
ONLY FOR AFIB PATIENTS
Congestive HF/LVD
HTN
Age >/= 75 (2 pts)
DM
Stroke/TIA (2 pts)
Vascular disease (CAP/PVD)
Age 65-74 years
Sex category is female
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20
Q

Scoring for CHA2DS2VASc

A

0: no anticoagulant
1: anticoagulant OR ASA 81-325 mg OR nothing
>/=2: Anticoagulant

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21
Q

Which anticoagulants can be reversed and with what?

A

Rivaroxaban
Apixaban
Edoxaban
Usuing activated prothrombin complex concentrate (blood transfusion, surgery, local pressure

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22
Q

Apixaban usages means you need to know

A

Weight
Age
Creatinine

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23
Q

Which anticoagulants have fewer strokes/embolism

A

Dabigatran
Apixaban
Edoxaban

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24
Q

Which anticoagulants have fewer or similar bleeding risk

A

Similar: Dabigatran and rivaroxaban
Fewer: Apixaban and Edoxaban

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25
Q

Risk factors for severe bleeding

A

Frequent falls
Noncompliance with warfarin therapy
Instability of INR
history of major bleeding

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26
Q

Rhythm control typically involves

A

Electrically DCC and if afib recurs DCC is performed and an anti-arrhythmic is added

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27
Q

Anticoagulation is required when?

A

When doing rate or rhythm control bc there is a risk of return to afib

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28
Q

Rate vs Rhythm control

A

No difference in mortality
Morbidity might be increased due to side effects and rehospitalization with rhythm
No difference in incidence of stroke

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29
Q

Acute Rate control without ADHF/HypoTN

A

BB or nonDHP-CCB

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30
Q

Acute Rate control with ADHF/HypoTN

A

Amiodarone or Digoxin

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31
Q

Chronic Rate Control

A

BB or nonDHP-CCB
Add digoxin
Add amiodarone (last line)
Possibly an antithrombotic

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32
Q

Rhythm control AF less than 48 hours

A

IV heparinoid

Cardiovert

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33
Q

Phythm Control >48 hrs

A

Anticoagulatio x 3 weeks
TEE
Cardiovert (electric +/- Rx)

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34
Q

New onset Afib patients that are stable,

A

you treat with rate control

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35
Q

Acute AF Rate Control

A

Titrate resting HR to less than 100 BPM
May use PO if stable or outpt
After stablized, consider transitioning to chronic AF

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36
Q

Chronic AF Rate Control

A

No HF: Titrate to HR less than 10 at rest
Yes HF: titrate agent to HR less than 80 BPM at rest
If symptoms remain, may tittrate to lower HR targets or attempt cardioversion

37
Q

Beta blockers in Acute AF

A

First line unless hypotension or ADHF

38
Q

Beta blockers in Chronic AF

A

First line esp for pts with chronic systolic HF

39
Q

nD-CCBs in Acute AF

A

First line unless hypotension or ADHF

40
Q

nD-CCB in Chronic AF

A

First line option if no compelling indication for BB

41
Q

Monitoring for nD-CCB and BB

A

HR, BP and signs and symptoms of HF

42
Q

AE for nD-CCB and BB

A

Bardycardia
Hypotension
Heart block
Worsend HF or CO

43
Q

BB and nD-CCB Notes

A

Avoid if they have HF at all

44
Q

Digoxin in Acute AF

A

Third line, okay in hypotension and ADHF

45
Q

Digoxin in Chronic AF

A

Second-line
Add to BB or nD-CCB
Single agent in sedentary pts

46
Q

Digoxin Monitoring

A

HR

Serum digoxin levels

47
Q

Digoxin AE

A 
Bradycardia
heart block
N/V
Visual disturbances
Interacts with CYP3A4 and PGP
48
Q

Amiodarone in acute HF

A

Second-line

Good in hypotension and ADHF

49
Q

Amiodarone in chronic HF

A

Third line

Add when other agent do not control HR

50
Q

Amiodarone chronic regimen

A

200 mg PO daily

100 mg if elderly or underweight

51
Q

Amiodarone Monitoring

A 
HR
Optic exam
CXR
Thyroid 
LFTs
52
Q

Amiodarone AE

A 
Pulmonary toxicity
Hypo/hyperthyroidism
Corneal deposits
Skin discoloration
QT prolongation
Interacts with many CYP and PGP
53
Q

Long-term rhythm control with medication is indicated when…

A

Intolerable symptoms with adequate rate control

Return to AF after successful cardioversion

54
Q

Antiarrhthmics can be used

A

In the days/weeks before cardioversion to increase the likelihood of obtaining and maintaing normal sinus rhythm

55
Q

Electrical

A

Direct cardioversion to reset the automaticity of the cardiac conduction system

56
Q

Electrical Risk

A 
Pain
Skin burns
Bradycardia
Other arrhythmias
Stroke
57
Q

Amiodarone Conversion? Maintenance?

A

In/outpts

Yes

58
Q

Amiodarone Contraindications

A

AV block

Bradycardia

59
Q

Amiodarone Side Effects

A

Torsades

60
Q

Sotalol (Betapace) Conversion?

Maintenance?

A

No

Yes

61
Q

Sotalol Contraindications

A

Prolong QTc

CrCl less than 40

62
Q

Sotalol Side Effects

A

Torsades
Worsened HF
Bradycardia
Heart block

63
Q

Sotalol is used in

A

Clean hearts and CAD

64
Q

Dofetilide (Tikosyn) Conversion? Maintenance?

A

Inpatient
Yes
- Not all doctors or pharmacies can dispense this

65
Q

Dofetilide Contraindications

A

Prolong QTc

CrCl less than 20

66
Q

Dofetilide Side Effects

A

Torsades

Dizziness and diarrhea (weird)

67
Q

Dofetilide Maintenance in:

A

CAD and HF

+ 3A4 interactions

68
Q

Ibutilide (Corvert) Conversion? Maintenance?

A

Inpatient

No

69
Q

Ibutilide Contraindications

A

Prolong QTc

LVEF less than 30%

70
Q

Ibutilide Side Effects

A

Torsades
Bradycardia
Heart block
Hypotension

71
Q

Ibutilide Notes

A

Very effective for conversion not for maintenance

3A4 interactions

72
Q

Dronedarone (Multaq)

A

Analog of amiodarone

Not used in conversion only as maintenance dose

73
Q

Dronedarone Side Effects

A 
N/D
Bradycardia
QT prolongation
No iodine 
Not in HF
74
Q

Class 3 anti-arrhythmics

A

Amiodarone
Sotalol
Dofetilide
Ibutilide

75
Q

Disopyramide (norpace) Class? Conversion? Maintenance?

A

1a
In-hospital
Yes but infrequently
- Chronic therapy only

76
Q

Dysopyramide contraindications

A

HR and shock

77
Q

Dysopyramide Side Effects

A

Anticholinergic
Torsades
Ventricular arrhythmias

78
Q

Propafenone (Rhythmol) Class? Conversion? Maintenance?

A

1c
Inhospital
Outpts or “pill-in-pocket”
Chronic or PRN

79
Q

Propafenone Contraindications

A

HF

Valvular disease LVH

80
Q

Propafenone Side Effects

A

Ventricular arrhythmias
Bradycardia
Heart block
Metallic taste

81
Q

Flecainide (Tambocor) Class? Conversion? Maintenance?

A

1c
Inhospital
OUtpt or “pill-in-pocket” PRN
PRN ONLY

82
Q

Flecainide Contraindications

A

HF
Valvular disease
LVH

83
Q

Flecainide AE

A 
Blurred vision
Dizziness
HF
Heart block
Ventricular arrhythmias
84
Q

Notes for Propafernone and Flecainide

A

Chronic thearpy for normal hearts

Pill-in=pocket: need pretreatment with BB or nD-CCB to prevent atrial flutter

85
Q

Class 1c is only used if

A

You have a normal heart structure and rate

86
Q

No Structural Disease Treametn

A 
Dronedarone
Flecainide
Propafenone
Sotalol
(last line amiodarone)
87
Q

CAD Treatment

A

Dofetilide
Dronedarone
Sotalol
(last line amiodarone)

88
Q

LVH Present Treatment

A

Amiodarone

Dronedarone

89
Q

HF Treatment

A

Amiodarone

Dofetilide

Cardio Final (12 decks)

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