atrial fibrillation2 Flashcards
(29 cards)
what are the two long term strategies for AF
- rhythm control
2. rate control
what is the preferred long term strategy for long term AF?
why?
rate control is preferred because drugs are tolerated better (less side effects)
what long term strategy is to leave patient in AF, and protect against complicatoins (stroke and V fib)?
rate control
what is the goal heart rate for patients on rate control treatment for AF?
110 bpm
what are two main drug classes that control ventricular rate slowing conduction through AV node
B-blockers
Ca- channel blockers
why is digoxin not typically prefered for rate control?
because act parasympathetically;
won’t work for active people alone (given in combo with BB or CaB)
what is always part of rate control therapy?
- control ventricular rate
2. protect from stroke
what rate control class would be prefered in a patient with asthma
Ca channel blocker
what type of long term treatment of AF has goal of NSR
rhythm control
what AF tx drug is not for maintenence therapy, just for cardioversion
ibutilide
what must be done in every patient after conversion to NSR
4 weeks of anticoagulation minimum
becausing of stunting of myocardial tissue take s a while to recover
what chronic maintenance sinus rhythm control therapy drugs are preferred if no comorditities are present
dronedarone
flecainide
propafenone
sotalol
what chronic maintenance sinus rhythm control therapy drugs can’t be used with hypertension and thickining of ventricular walls (LVH)
dronedarone
flecainide
propafenone
sotalol
what is catherter ablation?
what type of patients can have this?
cathater inserted in groin that burns out any arrhythmia causing tissue.
any patient despite comorbitity
what chronic maintenance sinus rhythm control therapy drug is preferred in patients with hypertension and LVH
amiodorone
what chronic maintenance rhythm therapy drug is preferred in patients with coronary artery disease
dofetalide
sotalol
what chronic maintenance sinus rhythm control therapy drug is preferred in patients with
amiodarone
dofetalide
what are the two “classic” drugs for decreasing risk of stroke
warfarin and aspirin
what is the therapeutic range of warfarin?
how much does it decrease the risk of stroke?
2-3
decrease risk by 62-68%
what is an advantage of aspirin over warfarin?
how much does aspirin decrease the risk of stroke
aspirin has less bleeding risk
decreases risk of stroke by 21%
what is the combination anticoagulants
ASA + clopidogrel
list the anticoagulation effects in order of least to most:
warfarin, aspirin, clopidogrel, aspirin + clopidogrel
aspirin < aspirin + clopidogrel < warfarin
what is the validated model used to predct the risk of eschemic stroke in patients with AF?
CHADS2
when should CHADS2 be used?
when should it not be used?
use w/ chonic AF (rate control or rhythm control tx)
don’t use w/ new onset AF
