Yale 2014 - 4 - Atrial Fibriliation - BPM

Question 1

What are elements to CHADS2?

Answer 1

CHF, HTN, Age >75, Diabetes, Stroke or TIA (=2points)

Question 2

What are some initial diagnostic work-ups for Afib?

Answer 2

EKG- irregular rhythm and absent P-waves
CXR- to identify pulmonary disease, PNA, CHF, COPD
CBC- anemia, infection
CMP- sodium, potassium, glucose, kidney function
Echo- heart size, shape, function, valvular dysfunctions
TSH- Hyperthyroidism

Question 3

What is the goal heart rate for Afib patients?

Answer 3

Less than 80bpm at rest and less than 110bpm with exercise

Question 4

What are the elements to Afib management?

Answer 4

Rate control for most patients with beta blocker or nondihydropyridine calcium channel blocker

Anticoagulation with ASA (for low risk) or warfarin, clopidogrel or dabigatran if CHADS2= 2 or greater

Rhythm control/ cardioversion electrically or pharmacologically with propafenone or amiodarone

Question 5

How do you assess bleeding risk for warfarin?

Answer 5

Outpatient bleeding risk index:
Age> 65
Hx of CVA
HX or current GIB
One or more of the following: recent MI, severe anemia,
Hct1.5)

0= low (3% risk)
1-2=intermediate (12% risk)
3-4=high (48% risk)

Question 6

What are contraindications to warfarin?

Answer 6

Hypersensitivity to warfarin, severe liver disease, recent trauma or symptoms of active bleeding