Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why is it just Afib?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define Rapid ventricular response (RVR)

A

Ventricular hear rate > 100 BPM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define Paroxysmal AF

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define Persistent AF

A

Continuous AF that is > 7 days in duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define Permanent AF

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complications of Afib

A

Stroke (CHADVASc)

Cardiomyopathy (long term consequence of rapid ventricular response)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

*****EMERGENCY SYMPTOMS

A

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

IMMEDIATELY CARDIOVERT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Causes of Atrial Distension

A 
Ischemia/MI
Pulmonary embolism, pneumonia, COPD/asthma, HF exacerbation
Chronic HTN
Valvular disease
Cardiomyopathy
Pulmonary HTN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Causes of high adrenergic tone

A 
Hyperthyroidism
Drug use: EtOH withdrawal, binge drinking, cocaine, amphetamines
Caffiene
Ephedrine
Sepsis
Beta agonists (inotropes)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Causes of Afib via surgery

A

CABG

Valve replacement or repair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Anticoagulation in Afib

A

CHADSVASC score for assessment of CVA risk and need for anticoagulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Rhythm control =

A

Cardioversion
Cardiovert
“return the heart to normal sinus rhythm”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Rate Control

A

Leave in AF and rate control to prevent symptoms and complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Rhythm Control

A

Convert patient from AF to sinus rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Duration less than 48 hours Treatment

A

UFH and Cardiovert

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Duration >48 hours

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Scoring for CHA2DS2VASc

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which anticoagulants can be reversed and with what?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Apixaban usages means you need to know

A

Weight
Age
Creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which anticoagulants have fewer strokes/embolism

A

Dabigatran
Apixaban
Edoxaban

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which anticoagulants have fewer or similar bleeding risk

A

Similar: Dabigatran and rivaroxaban
Fewer: Apixaban and Edoxaban

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Risk factors for severe bleeding
Frequent falls Noncompliance with warfarin therapy Instability of INR history of major bleeding
26
Rhythm control typically involves
Electrically DCC and if afib recurs DCC is performed and an anti-arrhythmic is added
27
Anticoagulation is required when?
When doing rate or rhythm control bc there is a risk of return to afib
28
Rate vs Rhythm control
No difference in mortality Morbidity might be increased due to side effects and rehospitalization with rhythm No difference in incidence of stroke
29
Acute Rate control without ADHF/HypoTN
BB or nonDHP-CCB
30
Acute Rate control with ADHF/HypoTN
Amiodarone or Digoxin
31
Chronic Rate Control
BB or nonDHP-CCB Add digoxin Add amiodarone (last line) Possibly an antithrombotic
32
Rhythm control AF less than 48 hours
IV heparinoid | Cardiovert
33
Phythm Control >48 hrs
Anticoagulatio x 3 weeks TEE Cardiovert (electric +/- Rx)
34
New onset Afib patients that are stable,
you treat with rate control
35
Acute AF Rate Control
Titrate resting HR to less than 100 BPM May use PO if stable or outpt After stablized, consider transitioning to chronic AF
36
Chronic AF Rate Control
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
Beta blockers in Acute AF
First line unless hypotension or ADHF
38
Beta blockers in Chronic AF
First line esp for pts with chronic systolic HF
39
nD-CCBs in Acute AF
First line unless hypotension or ADHF
40
nD-CCB in Chronic AF
First line option if no compelling indication for BB
41
Monitoring for nD-CCB and BB
HR, BP and signs and symptoms of HF
42
AE for nD-CCB and BB
Bardycardia Hypotension Heart block Worsend HF or CO
43
BB and nD-CCB Notes
Avoid if they have HF at all
44
Digoxin in Acute AF
Third line, okay in hypotension and ADHF
45
Digoxin in Chronic AF
Second-line Add to BB or nD-CCB Single agent in sedentary pts
46
Digoxin Monitoring
HR | Serum digoxin levels
47
Digoxin AE
``` Bradycardia heart block N/V Visual disturbances Interacts with CYP3A4 and PGP ```
48
Amiodarone in acute HF
Second-line | Good in hypotension and ADHF
49
Amiodarone in chronic HF
Third line | Add when other agent do not control HR
50
Amiodarone chronic regimen
200 mg PO daily | 100 mg if elderly or underweight
51
Amiodarone Monitoring
``` HR Optic exam CXR Thyroid LFTs ```
52
Amiodarone AE
``` Pulmonary toxicity Hypo/hyperthyroidism Corneal deposits Skin discoloration QT prolongation Interacts with many CYP and PGP ```
53
Long-term rhythm control with medication is indicated when...
Intolerable symptoms with adequate rate control | Return to AF after successful cardioversion
54
Antiarrhthmics can be used
In the days/weeks before cardioversion to increase the likelihood of obtaining and maintaing normal sinus rhythm
55
Electrical
Direct cardioversion to reset the automaticity of the cardiac conduction system
56
Electrical Risk
``` Pain Skin burns Bradycardia Other arrhythmias Stroke ```
57
Amiodarone Conversion? Maintenance?
In/outpts | Yes
58
Amiodarone Contraindications
AV block | Bradycardia
59
Amiodarone Side Effects
Torsades
60
Sotalol (Betapace) Conversion? | Maintenance?
No | Yes
61
Sotalol Contraindications
Prolong QTc | CrCl less than 40
62
Sotalol Side Effects
Torsades Worsened HF Bradycardia Heart block
63
Sotalol is used in
Clean hearts and CAD
64
Dofetilide (Tikosyn) Conversion? Maintenance?
Inpatient Yes - Not all doctors or pharmacies can dispense this
65
Dofetilide Contraindications
Prolong QTc | CrCl less than 20
66
Dofetilide Side Effects
Torsades | Dizziness and diarrhea (weird)
67
Dofetilide Maintenance in:
CAD and HF | + 3A4 interactions
68
Ibutilide (Corvert) Conversion? Maintenance?
Inpatient | No
69
Ibutilide Contraindications
Prolong QTc | LVEF less than 30%
70
Ibutilide Side Effects
Torsades Bradycardia Heart block Hypotension
71
Ibutilide Notes
Very effective for conversion not for maintenance | 3A4 interactions
72
Dronedarone (Multaq)
Analog of amiodarone | Not used in conversion only as maintenance dose
73
Dronedarone Side Effects
``` N/D Bradycardia QT prolongation No iodine Not in HF ```
74
Class 3 anti-arrhythmics
Amiodarone Sotalol Dofetilide Ibutilide
75
Disopyramide (norpace) Class? Conversion? Maintenance?
1a In-hospital Yes but infrequently - Chronic therapy only
76
Dysopyramide contraindications
HR and shock
77
Dysopyramide Side Effects
Anticholinergic Torsades Ventricular arrhythmias
78
Propafenone (Rhythmol) Class? Conversion? Maintenance?
1c Inhospital Outpts or "pill-in-pocket" Chronic or PRN
79
Propafenone Contraindications
HF | Valvular disease LVH
80
Propafenone Side Effects
Ventricular arrhythmias Bradycardia Heart block Metallic taste
81
Flecainide (Tambocor) Class? Conversion? Maintenance?
1c Inhospital OUtpt or "pill-in-pocket" PRN PRN ONLY
82
Flecainide Contraindications
HF Valvular disease LVH
83
Flecainide AE
``` Blurred vision Dizziness HF Heart block Ventricular arrhythmias ```
84
Notes for Propafernone and Flecainide
Chronic thearpy for normal hearts | Pill-in=pocket: need pretreatment with BB or nD-CCB to prevent atrial flutter
85
Class 1c is only used if
You have a normal heart structure and rate
86
No Structural Disease Treametn
``` Dronedarone Flecainide Propafenone Sotalol (last line amiodarone) ```
87
CAD Treatment
Dofetilide Dronedarone Sotalol (last line amiodarone)
88
LVH Present Treatment
Amiodarone | Dronedarone
89
HF Treatment
Amiodarone | Dofetilide

Cardio Final (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions