AFIB Flashcards
Which 3 drugs are used for rate control?
B-blocker (meto), CCB (diltiazem, verapamil), Digoxin
Which timeline defines paroxysmal Afib
terminates spontaneously or within 7 days
What timeline defines persistent afib
7 days up to a year
What timeline defines long-standing persistent
more than 12 months
What timeline defines permanent afib
no longer pursue rhythm control
What are 4 different means to do rhythm control?
Antiarryhytmic drugs, PerQ catheter ablation, Cardioeversion, or Surgery
What is the target goal for rate control?
60-100
If Afib patient HD unstable
Cardioevert
If acute Afb patient HD stable, that more than 48 hours old AND considering cardioeversion, what anticoagulation? what about alternative
3 weeks before CE and 4 weeks after CE or doing an TTE!!
CHADS2 score means?
C - CHF H - HTN A - Age > 75 D - DM S - Stroke/TIA/Embolism 2 pt
CHADS2-VASC
V - vascular disease (prior MI, PAD, or aortic plaque)
A - 65-74
S - sex = being a female
CHADS2 score >= 2
Warfarin with INR goal of 2-3
CHADS2 score = 1
Warfarin or ASA
CHADS2 score = 0
ASA 100-300
Bleeding risk score, HAS-BLED
H - HTN A - Abnormal liver or nrenal function S - stroke B - bleeding L - label INR E - Elderly age > 65 D - drugs or alcohol
name 2 types of novel oral anticogulants
- Direct Thrombin Inhibitor - gatran (Dabigatrn, Ximelagatran)
- Factor Xa inhibitor - xaban (Apixaban, rivaroxaban, Edoxaban, Betrixaban)
Side effect of direct thrombin inhibitor
liver toxicity
Benefit versus Disadvantage of NOAC
Benefit: convenience, small reduction in risk of ICH, less variation with dietary or drug interaction
Disadvantage: lack of adequate reversing agent, dose adjustment with CKD pts, hard to monitor blood level, higher cost, unidentified side effects
Which 3 advantages have Xaban shows
- lower risk of stroke/systemic clots
- lower risk of hemorrhagic stroke
- lower all-cause mortality
When must use warfarin rather than NOAC?
- Already on Warfarin with theurapeutic INR
- Unlikely to comply with BID dosing schedule
- severe CKD patients (creatinine clearance
Correct or Not: for pts with minimal sx or in those whom sinus rhythm cannot be easily achieved, rate control plus antithrombotic tx is the preferred tx strategy
Correct
Correct or Not: Avoid antiarrhythmic dtugs as the first line for AFib
Correct
How to interpret HAS-BLED score?
If CHADS2 score = 1 => ASA or Warfarin, but HAS-BLED score > 2, risk of bleeding may outweigh risk of stroke
if CHADS2 score >=2 => wafarin , but if HAS-BLEED score > CHADS2 score, risk of bleeding outweighs risk of stroke
When to consider about rhythm control?
Patient with unpleasant symptoms or decreased exercise tolerance on rate control
