AF/ conduction disorders highlights

Question 1

USPSTF screening recommendation for ages ____+ asymptomatic patients = I recommendation

Answer 1

50+

Question 2

Distinction between what 2 conditions is not that important bc management is similar?

Answer 2

Atrial flutter and AFIB

Question 3

Name 1 important non-modifiable risk factor for AFIB

Answer 3

Advancing age

Question 4

List 2 chronic illness conditions that put you at risk for AFIB

Answer 4

HTN, CAD

Question 5

Thyrotoxicosis (hyperthyroidism) is a major risk factor for what?

Answer 5

Secondary AFIB

Question 6

What are the common chief complaints with AFIB?

Answer 6

New onset palpitations, dyspnea, chest pain

Question 7

Why don’t you hear an S4 with HF and AFIB/ a flutter?

Answer 7

No atrial kick to form an S4 (not enough blood)

Question 8

What would you see on a 12 lead EKG for atrial flutter?

Answer 8

P waves in “saw tooth” pattern, often 2:1 block, more regular rhythm

Question 9

What would you see on a 12 lead EKG for AFIB?

Answer 9

No distinct p waves, irregular irregular rhythm, +/- rapid ventricular rate

Question 10

What other abnormalities should you assess for on a 12 lead EKG when diagnosing AF?

Answer 10

Ischemia, preexcitation, DDX conditions multifocal atrial tachycardia, & conduction d/o

Question 11

List 3 important labs you should do for both atrial flutter and AFIB

Answer 11

1) Cardiac biomarkers
2) BNP
3) TSH

Question 12

What is an important imaging tool used for assessing AFIB + atrial flutter?

Answer 12

ECHO

Question 13

List 3 key EKG findings with AFIB

Answer 13

1) Absence of P waves
2) Irregular irregular [ventricular rate (R-R)]
3) Narrow QRS

Question 14

List the 4 classifications of AFIB

Answer 14

1) Paroxysmal AF: 7 days
2) Persistent AF: >7 days sustained
3) Long standing: sustained for > 12 months
4) Permanent AF: no longer pursue rhythm control

Question 15

What should you Rx to manage most pts with AFIB?

Answer 15

Anticoagulation to prevent stroke

Question 16

Management of stable AF: Newer studies incorporating ______________________ show significantly decreased cardiovascular death and ischemic stoke vs. rate control

Answer 16

catheter ablation

Question 17

When should you not wait for anticoagulation to cardiovert AFIB?

Answer 17

If there’s hemodynamic instability

Question 18

List the 3 HAS-BLED risk categories

Answer 18

1) A scoreof 0 to 1: Low risk for major bleeding. Anticoagulation should be considered.
2) A score of 2: Moderate risk for major bleeding. Anticoagulation can be considered.
3) A score of 3:High risk for major bleeding.Alternatives to anticoagulation should be considered.

Question 19

HAS-BLED estimates ____________ risk of major bleeding in patients with AF

Answer 19

1 year

Question 20

True or false: antiplatelets and anticoagulants are not the same

Answer 20

True

Question 21

How do you calculate CHA2DSVASC scores?

Answer 21

Question 22

How do you calculate HAS-BLED scores?

Answer 22

Question 23

Preferred drugs for rate control in AF without significant left HFrEF are what?

Answer 23

B-blockers or non-dihydropyridine calcium channel blockers (verapamil or diltiazem)

Question 24

Preferred drugs for rate control in AF with significant left HFrEF are what?

Answer 24

B-blockers

Question 25

32

Answer 25

Anticoagulation (AC) is required for at least 3 weeks prior and 4 weeks post cardioversion if AF present for at least 48 hour or unknown duration

Question 26

1) Pill in the pocket (PITP) is an option for ______________ AFIB 2) What specific meds?

Answer 26

1) paroxysmal 2) Flecainide or propafenone widely used, ranolazine used off label

Question 27

What is the preferred treatment for restoration of NSR with atrial flutter?

Answer 27

Ablation