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STEP 2 Cardio + Renal > AF, Aflutter 09-x (1) > Flashcards

AF, Aflutter 09-x (1) Flashcards

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1
Q

AF ectopic location?

A

pulmonary veins

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2
Q

AF ECG? 3

A

Irregularly irregular rhythm with varying R-R intervals
No clearly discernible P waves
Narrow-complex tachycardia

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3
Q

AF symptoms?

A

Palpitations
Weakness/fatigue
Dizziness
Presyncope
Dyspnea
Chest pain/tightness

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4
Q

AF ventricular response?

A

HR > 150 k/min.

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5
Q

AF. Hemodynamically unstable?

A

Syncope
Symptomatic hypotension
Acute HF, pulmonary edema
Ongoing myocardial ischemia
Cardiogenic shock

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6
Q

paroxysmal AF?

A

AF that terminates sponateously OR with intervention within 7 days of onset.

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7
Q

AF that terminates sponateously OR with intervention within 7 days of onset?

A

paroxysmal AF?

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8
Q

Persistent AF?

A

AF that is continuously sustained beyond 7 days, including episodes terminated by cardioversion (drug or electrical cardioversion) after >= 7 days.

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9
Q

AF that is continuously sustained beyond 7 days, including episodes terminated by cardioversion (drug or electrical cardioversion) after >= 7 days.

A

Persistent AF

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10
Q

Long-standing persistent AF?

A

Continuous AF > 12 months when decided to adopt a rhythm control stategy

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11
Q

Continuous AF > 12 months when decided to adopt a rhythm control stategy

A

Long-standing persistent AF

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12
Q

Permanent AF?

A

AF that is accepted by the patient and physician, an no further attempts to restore/maintain sinus rhythm will be undertaken.

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13
Q

AF that is accepted by the patient and physician, an no further attempts to restore/maintain sinus rhythm will be undertaken.

therm should now be used in the context of a rhythm control strategy with antiarrhytmic drug therapy or AF ablation.

A

Permanent AF

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14
Q

AF DIAGNOSTIC CRITERIA? 2

A

12-lead ECG recording
OR
single-lead ECG tracing of >=30 s

If fulfills this criteria –> it is CLINICAL AF.

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15
Q

Primary diagnostic workup for AF?

A

Medical history: AF related symptoms, AF patterns, concomitant conditions, CHA2DS2VAS2 score; 12 lead ECG, Thyroid and kidney function, electrolytes, full blood count, TTE.

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16
Q

AF management abreviation?

A

ABC pathway

A Anticoagulation/Avoid stroke;

B Better symptom management;

C Cardiovascular and Comorbidity optimization

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17
Q

CHA2DS2-VASc. C?

A

Congestive heart failure

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18
Q

CHA2DS2-VASc. H?

A

Hypertension
Also patients on antihypertensive therapy

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19
Q

CHA2DS2-VASc. A2?

A

Age >= 75

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20
Q

CHA2DS2-VASc. D?

A

DM

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21
Q

CHA2DS2-VASc. S2?

A

Stroke/TIA/Thromboembolism

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22
Q

CHA2DS2-VASc. V?

A

Vascular disease - prior. MI, PAD, aortic plaque, angiographically significant CAD

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23
Q

CHA2DS2-VASc. A?

A

age 65-74 y/o

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24
Q

CHA2DS2-VASc. Sc?

A

Sex category - i.e. FEMALE

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25
AF + NO prosthetic valve or mitral stenosis. What is the 1 step?
Identify low risk patients, i.e. Male 0 points, female 1 point.
25
AF + NO prosthetic valve or mitral stenosis. If patients is low risk, what anticoagulation?
NO ANTICOAGULATION
26
AF + NO prosthetic valve or mitral stenosis. Patient IS NOT LOW RISK. If patient is intermediate risk? what score and what treatment?
Male >= 1 Female >= 2 OAC should be CONSIDERED (individually)
27
AF + NO prosthetic valve or mitral stenosis. Intermediate risk. Which 2 points carries highest tromboembolism risk?
Age 65 to 74 years (pats stipriausias faktorius!!!!) and the presence of heart failure --> GIVE OAC
28
AF + NO prosthetic valve or mitral stenosis. Intermediate risk. When OAC not needed?
low burden of AF (eg, AF that is well documented as limited to an isolated episode that may have been due to a reversible cause such as recent surgery, heavy alcohol ingestion, or sleep deprivation
29
What is recommended for anticoagulation in general?
NOAC > warfarin
30
AF + NO prosthetic valve or mitral stenosis. Patient IS HIGH risk. what score and what treatment?
Male >= 2 Female >=3 OAC RECOMMENDED
31
AF + YES prosthetic valve or mitral stenosis. treatment?
VKA (warfarin) INR range depends on type of valve lesion or prosthesis
32
When initiating antithrombotic therapy, what need to evaluate?
Bleeding risk according to HAS BLED scale
33
HAS BLED. H?
Hypertension
34
HAS BLED. A?
Abnormal RENAL and/or HEPATIC function (dialysis, transplant, creat. >200, cirrhosis, bilirubin > x2 upper limit, AST/ALT/ALP > 3 x upper limit each gets 1 point (renal/hepatic)
35
HAS BLED. S?
Stroke previous ischemic or hemorrhagic
36
HAS BLED. B?
Bleeding history or predisposition Prior major bledding or anemia or severe thrombocytopenia
37
HAS BLED. L?
Labile INR (TTR < 60 proc. in patient receiving VKA) Only relevant if patient receiving a VKA.
38
HAS BLED. E?
Elderly > 65 y/o or extreme frailty
39
HAS BLED. D?
Drugs or excessive alcohol drinking Alcohol excess or abuse refers to a high intake (e.g. >14 units per week),
40
Absolute contraindications for OAC. Blood diseases?
severe thrombocytopenia <50 platelets/lL or known coagulation defect associated with bleeding, severe anemia under investigation
40
Has bled - what score high risk?
High risk of bleeding (HAS-BLED score >=3)
41
High bleeding risk in HAS BLED. What to do with OAC?
high bleeding risk score should NOT lead to withholding OAC, as the net clinical benefit of OAC is even greater amongst such patients
42
Absolute contraindications for OAC. bleeding?
active bleeding, concern for ongoing bleeding, recent surgery, recent high-risk bleeding event such as intracranial haemorrhage (ICH)
43
Absolute contraindications for OAC. vessel? 2
Aortic dissection Malignant hypertension
44
Antiplatelet therapy for AF?
NOT recommended for stroke prevention in AF.
45
AF rivaroxaban standard dose?
20 mg 1k/d.
46
AF rivaroxaban reduced dose?
15 mg 1/kd.
47
When do we reduce rivaroxaban dose? 2 reasons
CrCl < 50 ml/min Should be considered lower dose when Has Bled high risk and patient takes mono or dual antiplatelet therapy
48
AF apixaban standard dose?
5 mg 2 k/d.
49
AF apixaban lower dose?
2,5 mg 2k/d.
50
when do we reduce apixaban dose?
2 of 3 criteria Age >= 80 y/o Weight =< 60 kg Creatinine > 133
51
AF and antiplatelet therapy, need warfarin. Dose?
Dosing shoud be carefully regulated with target INR of 2-2,5 and TTR > 70 proc.
52
RATE CONTROL. No comorbidities or hypertension or HFpEF > 40 proc.?
First line: BAB or NCCB
53
RATE CONTROL. No comorbidities or hypertension or HFpEF > 40 proc.. No response to first line?
DIGOXIN and/or BAB/ and or NCCB
54
RATE CONTROL. HFrEF <40%? first line
First line is BAB
55
RATE CONTROL. HFrEF <40%? no response to first line?
BAB and/or DIGOXIN and/or amiodarone
56
RATE CONTROL. Severe COPD or Asthma. First line?
first line NDCC
57
RATE CONTROL. Severe COPD or Asthma. no response to first line?
NDCC and/or Digoxin
58
metoprolol, bisoprolol are cardioselective, therefore use in asthma DO not use propranolol
.
59
target HR?
<110 bpm
60
Rhythm control. First thing we evaluate?
HD stability
61
Rhythm control. Unstable. What to do?
Emergency electrical cardioversion THEN Check OAC status and ASAP decide on OAC. If CHADSVAS intermediate or high risk --> long term OAC.
62
Rhythm control. Stable. What to evaluate?
if on OAC
63
Rhythm control. Stable and on OAC. Whats next?
Cardioversion as desired: immediate OR delayed for possible spontaneous atsistatymui. --> then CHADSVAS and decide on OAC
64
Rhythm control. Stable and NOT OAC. Whats next?
Start ASAP NOAC or LMWH or UHF
65
Rhythm control. Stable and NOT OAC --> you started OAC. what to check next?
Check current AF episode duration
66
Rhythm control. Stable and NOT OAC --> you started OAC. If duration from onset < 48h?
Early cardioversion: pharm or electrical. OR Wait for delayed cardioversion = wait spontaneous atsistatymo arba pharm/electr. within 48h.
67
Rhythm control. Stable and NOT OAC --> you started OAC. If duration from onset < 48h and choose EARLY. What are the ideal cadidates? 2
AF onset <12 val and no previous TE AF onset 12-48h and chadsvas 1 in males, 2 in females.
68
Rhythm control. Stable and NOT OAC --> you started OAC. If duration from onset < 48h and choose DELAYED. What are the ideal camdidates? 2
AF onset <12 val and no previous TE AF onset =< 24h and chadsvas 1 in males, 2 in females.
69
After early or delayed also proceed to CHADSVAS and decide long term OAC
.
70
Rhythm control. Stable and NOT OAC --> you started OAC. If duration from onset > 48h. what can be cardioversion?
ELECTIVE cardioversion: both pharm and electrical
71
Rhythm control. Stable and NOT OAC --> you started OAC. If duration from onset > 48h. what are 2 requirement to perform?
Within < 3 weeks of therapeutic OAC + NO LA thrombus on TTE. After > 3 weeks of therapeutic OAC.
72
Rhythm control. Stable and NOT OAC --> you started OAC. If duration from onset > 48h. 3 ideal candidates?
AF >=48h or unknown duration AF 12-48h + Chadsvas high risk (2/3 score) AF with previous TE or mitral stenosis or prostetic valve.
73
Rhythm control - when indicated? 3 reasons
Unable to achieve adequate heart rate control (resting should be <110 bpm) Recurrent symptomatic episodes – we perform cardioversion to alleviate AF symptoms Heart failure symptoms
74
New AF. what important to evaluate?
All patients with new-onset AF should be evaluated for occult hyperthyroidism
75
Precipitants of atrial dilation and/or conduction remodeling?
HTN – most common predisposing factor MV dysfunction Left ventricle failure, CAD, CAD-related factors (CD, smoking) OSA, obesity Chronic hypoxic lung disease (eg. COPD, pneumonia) Atrial septal defect
76
Triggers of increased automaticity
Hyperthyroidism Excessive alcohol use Increased sympathetic tone - Acute illness (sepsis, PE, MI) - Cardiac surgery Sympathomimetic drugs (eg cocaine, amphetamines)
77
Aflut. location?
reentrant circuit around the tricuspid annulus, which is called cavotricuspid isthmus.
78
Aflut. ECG?
Findings a. Rapid rate b. “Sawtooth” flutter waves

STEP 2 Cardio + Renal (55 decks)

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