atrial fibrillation

Question 1

What is the primary goal of pharmacological treatment for AF?

Answer 1

To control the ventricular rate and restore sinus rhythm

Question 2

Which medications are used to control ventricular rate in AF?

Answer 2

• Beta blocker
• Rate-limiting CCB

Question 3

What should be avoided in patients with HF and risk of pulmonary edema?

Answer 3

Beta blockers and rate-limiting CCB

Question 4

What should be used if AF is not controlled with monotherapy?

Answer 4

Digoxin or diltiazem

Question 5

What type of medication is digoxin?

Answer 5

Cardiac glycoside; increases myocardial contraction force

Question 6

What is the daily dose range for digoxin?

Answer 6

62.5-250 mcg

Question 7

What is an important consideration when using digoxin?

Answer 7

Narrow therapeutic range and many drug-drug interactions (DDIs)

Question 8

How should the dose of digoxin be adjusted?

Answer 8

Use pulse to adjust dose

Question 9

What is the risk associated with AF regarding blood flow?

Answer 9

Risk of sluggish blood flow and embolism of thrombus in left atria, leading to stroke

Question 10

What two risks must be balanced in patients with AF?

Answer 10

• Risk of stroke
• Bleeding risk from anticoagulants

Question 11

Which scores are used to calculate stroke risk and bleeding risk?

Answer 11

• CHA2DS2-VASc for stroke risk
• ORBIT for bleeding risk

Question 12

What factors are included in the ORBIT bleeding risk calculation?

Answer 12

• Older age
• Reduced Hb
• Bleeding history
• Insufficient kidney function (eGFR < 40)
• Treatment with antiplatelet

Question 13

What are the DOACs used for anticoagulation?

Answer 13

• Edoxaban
• Apixaban
• Rivaroxaban
• Dabigatran

Question 14

What are the advantages of DOACs?

Answer 14

• Better kinetics
• Can have fixed dosing
• Less food and DDI

Question 15

What is an important consideration for dosing DOACs?

Answer 15

Renally excreted; consider renal function and may need dosing adjustments

Question 16

When are DOACs recommended for patients?

Answer 16

For patients with CHA2DS2-VASc score >2 and AF

Question 17

What should be used if DOACs are not tolerated?

Answer 17

Vitamin K antagonist, e.g., warfarin

Question 18

What does warfarin inhibit?

Answer 18

Synthesis of clotting factors II, VIII, IX, and X

Question 19

What is the beneficial INR range for patients on warfarin?

Answer 19

INR of 2-3

Question 20

What risks are associated with low and high INR levels in warfarin therapy?

Answer 20

• Low INR increases stroke risk
• High INR increases bleeding risk

Question 21

What is a key characteristic of warfarin in terms of therapeutic index?

Answer 21

Has a narrow therapeutic index; vary dose to reach target INR

Question 22

What is more prevalent in increasing age?

Answer 22

Atrial Fibrillation (AF)

AF tends to occur more frequently as individuals age.

Question 23

What causes irregular contraction in the ventricles during AF?

Answer 23

Rapid and uncoordinated electrical activity in atria and variable conduction through the AV node

This leads to a lack of coordinated pumping action from the heart.

Question 24

What are the two types of Atrial Fibrillation?

Answer 24

VALVULAR and NON-VALVULAR

The classification is based on the underlying causes related to heart valves.

Question 25

Which age group is predominantly affected by non-valvular AF?

Answer 25

>65 years old ## Footnote Non-valvular AF is common in older adults, particularly those with specific health conditions.

Question 26

List three health conditions that increase the risk of non-valvular AF.

Answer 26

* Hypertension (HT) * Atherosclerosis * Hyperthyroidism ## Footnote These conditions are significant risk factors for developing AF.

Question 27

What lifestyle factors can act as a risk for AF?

Answer 27

Various lifestyle factors ## Footnote Specific lifestyle choices may contribute to the development of AF.

Question 28

What are common symptoms of Atrial Fibrillation?

Answer 28

* Dizziness * Shortness of breath (SOB) * Tiredness * Palpitations * Chest pains/discomfort * Risk of thromboembolic stroke * Can exacerbate heart failure (HF) and cause tachycardia induced cardiomyopathy ## Footnote These symptoms can affect the quality of life and overall health of individuals with AF.

Question 29

What is the first step in assessing rate and rhythm in suspected AF?

Answer 29

Checking for an irregular pulse and for the presence of any symptoms ## Footnote This is a crucial initial assessment before further testing.

Question 30

What test is done if an irregular pulse is detected?

Answer 30

12 lead ECG ## Footnote An ECG provides a detailed look at the heart's electrical activity.

Question 31

What does an ECG signal strip measure?

Answer 31

The length of time it takes for the initial impulse to fire at the sinoatrial node and end in the contracting ventricles ## Footnote This measurement is essential for diagnosing heart rhythm issues.

Question 32

What is the significance of the p-wave in an ECG?

Answer 32

It is formed when the atria contract to pump blood into the ventricles ## Footnote In AF, the p-wave is typically absent or replaced by fibrillation beats.

Question 33

In AF, what do you see instead of one P wave?

Answer 33

Many fibrillation beats ## Footnote This indicates disorganized electrical activity in the atria.