A- Fib +CHF

Question 1

What type of rhythm is A fib

Answer 1

irregularly irregular

Question 2

facts about a fib

Answer 2

most common sustained arrhythmia

affects 1% of the population

Question 3

Is A fib life threatning

Answer 3

NO

Question 4

Common causes

Answer 4

1. Htn
2. Valvular dz
3. CAD
4. Cardiomyopathy
5. PE
6. Alcohol (“holiday heart syndrome”)

Question 5

Clinical presentation of A fib

Answer 5

may be asymptomatic

palpitations, dizziness, lightheadedness, SOB, fatigue, CP

Question 6

Risks involved with having A fib

Answer 6

Clot thrombus formation in the left atrial appendage
CHF
Tachycardic-induced cardiomyopathy
Syncope

Question 7

A fib therapy

Answer 7

Rate- BB, CCB, Dig, anticoagulation

Rhythm- antiarrhythmics, cardioversion, surgery

Question 8

What is the CHADS2 score?

Answer 8

determines who we should anticoagulate
C- CHF=1
H- Htn= 1
A- Greater than 75= 1
D- Diabetes= 1
S- stroke, TIA= 2
CHADS score greater than 2= anticoagulation
CHADS score of 1=  clinical decision
CHADS score of 0= full strength asprin

Question 9

What does the modified CHADS score include

Answer 9

V- Vascular
A- 65-74= 1
A- over 75=1
S= Female sex= 1

Question 10

Coumadin reversal

Answer 10

Vit K (24 hours)
FFP

Question 11

Therapeutic INR for A fib

Answer 11

2-3

Question 12

Therapeutic INR for mechanical valve

Answer 12

2.5-3.5

Question 13

INR is for

Answer 13

Coumadin

Question 14

PTT is for

Answer 14

Heparin

Question 15

PTT for coagulated individuals

Answer 15

60-85 seconds

Question 16

Reversal of Heparin

Answer 16

Protamine

Question 17

Onset of action of heparin

Answer 17

Immediate (IV), 20-30 mins (SQ)

Question 18

Onset of action for coumadin

Answer 18

24-72 hours with terapeutic effect in 5-7 days

Question 19

Name some class 1 anti-arrhythmics

Answer 19

Tambocor (Flecanide)

Propafenone (Rhythmol)

Question 20

Name some class 2 anti-arrhythmics

Answer 20

Beta blockers!!–> Betapace (sotalol)

Question 21

Name some class 3 anti-arrhythmics

Answer 21

Amniodarone
Dronadrone
Ibutilide (Corvert)– rapid
Dofetilide (Tikosyn)- CHF

Question 22

Serious side effects of amniodarone

Answer 22

Pulmonary fibrosis
Hyper/hypothyroidism
Liver toxicity

Question 23

Surgical options for a fib

Answer 23

AV node ablation with pacemaker
AV node modification
A-fib catheter ablation

Question 24

Symptoms of CHF

Answer 24

Fluid accumulation and retention
SOB/Dyspnea on exertion
Orthopnea
PND
Edema
Ascites
Non-productive cough

Question 25

Left sided CHF symptoms

Answer 25

Pulomonary edema- rales+crackles orthopnea PND

Question 26

Right sided CHF symptoms

Answer 26

``` peripheral edema anascara (swelling under skin) Ascites JVD Hepatomegaly ```

Question 27

New york heart association functional classification

Answer 27

Class 1- No limitations Class 2- mild limitation, symptoms with ordinary activity Class 3- moderte limitation, symptoms with less than ordinary activities Class 4 - symptoms at rest

Question 28

ACC/AHA guidlines+stages

Answer 28

Stage A- High risk, without structural disease Stage B- Structural disease Stage C- Past or present symptoms of CHF Stage D- refractory end stage CHF

Question 29

PE findings of CHF

Answer 29

``` JVD S3 or S4 Lateral deviation of apical impulse Rales Peripheral edema Tachycardia Ascites Labored breathing ```

Question 30

Tell me about frank-starling

Answer 30

Cardiac output increased or decreased in response to changed in the heart rate or stroke volume (volume of blood with each heart beat)

Question 31

Where will the frank-starling curve be in CHF

Answer 31

Shiffted downward, or to the right

Question 32

What is the problem with CHF

Answer 32

Decreased Cardiac output leading to blood back up

Question 33

Systolic CHF characteristics and causes

Answer 33

Loss of contractility+Reduced EF | Causes- MI, HTN, valvular dz

Question 34

Diastolic CHF characteristic and causes

Answer 34

stiffness + impaired relaxation or the ventricle 40% of all CHF Ventricular hypertrophy, HTN, CAD

Question 35

CXR findings of CHF

Answer 35

increased interstitial markings, pleural effusions, Kerley B lines, cardiomegaly

Question 36

EKG findings of CHF

Answer 36

LVH, A fib, Old MI, ischemia

Question 37

Echo findings of CHF

Answer 37

decreased EF and hypertrophy

Question 38

Blood tests for CHF

Answer 38

BNP (above 400)

Question 39

Treatment of CHF

Answer 39

Lifestyle modifications- sodium and fluid restriction Medications- Diuretics, ace, arb, nitrateds, BB, dig, inotropes (dopamine, dobutamine) ICD Heart transplant or LVAD

Question 40

What is the role of diuretics in treating CHF

Answer 40

Control volume

Question 41

What is the role of ACE and ARB

Answer 41

Slow disease progression, Works on the renin-angiotensin-aldosterone axis Vasodialates + decrease afterload

Question 42

What is the role of Digoxin in CHF

Answer 42

treat residual symptoms, makes heart squeeze harder by increaseing intracellular calcium and slows AV conduction USED for SYSTOLIC

Question 43

What is the role of beta blockers in CHF

Answer 43

Slows disease progression when given with ACE | decreases contractility

Question 44

What is the role of hydralazine and nitrated in CHF

Answer 44

Vasodialate | African americans do better with this combo

Question 45

What is the role of inotropes (dopamine, doubotomine) in CHF

Answer 45

Increase cardiac contractility and cardiac output Used in Severe decomp CHF INCREASES MORTALITY Short term solution

Question 46

Who gets and ICD with CHF

Answer 46

Stage B+C

Question 47

when is someone too old for a heart transplant

Answer 47

65

Question 48

indications for heart transplant

Answer 48

end stage disease with no other option

Question 49

LVAD

Answer 49

takes over or assists with the pumping of the LV