Atrial Fibrillation Flashcards
(43 cards)
AFib is the? Explain the types of Afib?
• THE most common sustained arrhythmia • Can be paroxysmal, persistent or permanent • Paroxysmal (PAF) – Start/stop spontaneously – Duration < 24 hours; usually minutes to few hours • Persistent – Duration < 7 days, or – Requires chemical or electrical termination • Permanent (Chronic) – Does not respond to therapy
Valvular Afib? Non-valvular?
Valvular stenosis (MS) Prosthetic valve Non-valvular: Garden variety AF (HTN, diabetes, heart disease)
Explain the risk of stroke in AFL and AFib?
• Risk of stroke is higher in both AF and AFL • There may be a continuum of increasing risk with increasing disorganization of atrial activity • Thrombus formation in LAA: > 95% – LAA has tremendous anatomical variation • Mechanism of thrombus formation – Mechanical dysfunction with stasis of blood – Pro-inflammatory state – Pro-coagulant state
The clinical decision for anticoagulants with afib/AFL?
• AF = AFL in terms of stroke risk – Rx the same • PAF = Persistent = Permanent in stroke risk • So, clinical decision regarding anticoagulation is NOT based on the arrhythmia but on the risk factors – CHADS2 or CHADS2-VA2 Score
AF medical statistics?
AF is important Common Prevalence is increasing Disability and Death Stroke – risk is 5 x Symptoms QOL Associated with 2x mortality Expensive PH issue Medicare $20B
ABC’s of Afib?
Treatment Imperatives A: Anticoagulate / ASA / Appendage closure B: Best Rhythm ? SR or is rate control adequate? If SR, attempt FIRST o/w, it may be too late C: Control rate ?
What is the leading cause of hospitalizations for Arrhythmia?
AF Is the Leading Cause of Hospitalizations for Arrhythmia
80% of patients with MS who develop embolism, have?
AF
Stroke incidence? 90% of strokes are? AF is the most______?
800,000 – 900,000 per year in the U.S. 90% of all strokes are ischemic strokes > 30% are unexplained = cryptogenic (> 200,000 per year) AF is the most common underlying cause of cryptogenic strokes (30-40%)
Afib can cause? Onset? effects on HF?
• Palpitations, SOB, dizziness, not feeling well • Exercise intolerance • Onset may be gradual… – may be hard for some patients to recognize – often attributed to “age” • Worsens HF – Tachycardia-induced cardiomyopathy – LVH / HCM (hypertrophic cardiomyopathy) – loss of AV synchrony
AF increases stroke risk by?
AF: Stroke risk by 3-5 fold • Strokes – ischemic (90%) or hemorrhagic (10%) • 30-40% of ischemic strokes are cryptogenic; i.e. 1/3 of ALL strokes • AF is the most common cause of cryptogenic strokes • AF-strokes are WORSE than “non-AF” strokes – because of larger infarctions • Since AF is increasing, we WILL see more strokes in the future
AF and mortality?
AF is associated with increased Mortality • Association may not be causal – but AF is a bad sign! • Patients with HF – AF is associated with 2x increased mortality • Patients with ICD – AF is associated with 2x increased mortality
AF expenses?
• 80% of AF patients are > 65 years age1 • Medicare is the primary payer for AF care in the US:2 – Hospital inpatient 78.4% – Hospital outpatient 56.4% – Emergency department 61.4% – Physician office 69.4% • Medicare spends > 16 Billion annually3 • 60-70% of health care costs due to hospitalizations They are at the hospital more often and use more resources?
3 reasons to treat AF?
C: Common; most prevalent arrhythmmia D: Disability and Death E: Expensive for health care systems AND – AF gets worse with time
Outcomes of AF?
Explain the fibrosis in Afib? Indicator of? What scorring is used?
CHADS2 scores are composed of what areas?
- Congetive Heart Failure or EF < 35% = 1 • Hypertension = 1 • Age > 75 = 1 • Diabetes = 1 • Stroke or prior TIA = 2
- Possible scores = 0 - 6
CHADS2 stroke risk with score
CHADS2 Score, stroke risk and prevention
0 1.9% Low ASA or nothing
1 2.8% Moderate ASA or anticoagulation
2 4.0% “ anticoagulation
3 5.9% High “
4 8.5% “ “
5 12.5% “
6 18.2%
Explain the CDA2DS2-VASc scoring system?
C = Congestive Heart Failure
H = Hypertension
A = Age > 75 = 2 points
D = Diabetes
S = Stroke (TIA) = 2 points
V = Vascular Disease (MI, PAD, Aortic atherosclerosis)
A = Age 65 -74 = 1 point
Sc = Sex category (Females = 1)
MAXIMUM = 9 points 0 = ASA; 1 = ASA or anticoagulation; ≥2 = anticoagulation
Management imperatives of Afib?
Management Imperatives: A, B, C
A = Anticoagulate or ASA? B = Best rhythm? C = Controlled rate?
Anticoagulants in Afib?
• Warfarin (Coumadin) • Dabigatran (Pradaxa) • Rivaroxaban (Xeralto) • Apixaban (Elequis)
Mechanism of action of Apixaban Rivaroxaban? Dabigatran? these are examples of?
Examples of novel oral anticoagulants
Novel oral anticoagulants as effective as?
- Risk of stroke in AF has nothing to do with whether AF is paroxysmal, persistent or permanent
- Risk of stroke is the same in patients with AF and AFL
- NOACs ≈ warfarin
Aspirin, Plavix, or Anticoagulation ?
Aspirin, Plavix, or Anticoagulation ?
Anticoagulation > ASA
Anticoagulation > ASA + Plavix AND, bleeding risk is
the same
New Anticoagulants ≈ warfarin
