Atrial Flutter & Fibrilation Flashcards
1
Q
define a.fib
A
disorganized, rapid, and irregular atrial contraction
2
Q
What does a.fib result in?
A
- non-effective contractility
- irregular ventricular response
- tachycardia (120-160bpn)
- thrombus/clot
3
Q
What is the MC arrhythmia?
A
a.fib
4
Q
What is the MC cause of TIA?
A
a.fib
5
Q
epidemiology of a.fib
A
- 65+ y/o
- males more than females
6
Q
etiology of a.fib
A
often related to stretching
- hyperthyroidism
- vagotonic episodes
- ETOH toxicity
- post-op
- atrial enlargement d/t end stage R heart failure
- disruption of electrical conduction system
7
Q
pathophysiology of a.fib
A
- incr atrial pressure
- triggered by atrial premature beats or other supraventricular arrhythmia
- ectopic foci most commonly located at osteal portion of pulm. v.
8
Q
risk factors for a.fib
A
- 64+ y/o male
- HTN
- incr BMI
- prolonged PR interval
- valvular dz
- CHF
9
Q
classifications of a.fib
A
- paroxysmal (PAF)
- persistent
- permanent
- “Lone”
10
Q
describe PAF
A
intermittent
11
Q
describe persistent a.fib
A
- does not self-terminate w/in 7d
- requires intervention to convert
12
Q
describe permanent a.fib
A
12+ mo
13
Q
describe Lone a.fib
A
- without structural heart disease
- lowest risk of complications
14
Q
diseases associated with a.fib
A
- valvular dz (sig. stenosis/regurg and rheumatic heart dz)
- heart failure d/t dilation
- hypertensive heart disease
- acute MI
15
Q
symptoms of a.fib
A
- asx
- heart palpitations
- lightheadedness, pre-syncope, syncope d/t decr BP and incr HR
- SOB + DOE
- chest pain (rare)
- fatigue
16
Q
common triggers of a.fib
A
- sleep deprivation
- physical illness
- post-op
- stress
- hyperthyroidism
- exercise
- stimulant rx
- ETOH
- caffeine
- dehydration
17
Q
initial presentation of new onset a.fib
A
- heart palpitations
- fatigue
- SOB
- angina
18
Q
physical exam of a.fib
A
- decr. BP, incr. HR
- irregularly irregular pulse (check for DVT)
- murmurs
- evidence of heart failure (incr. JVP, crackle, edema)
19
Q
diagnostics for a.fib
A
- EKG = no p waves, irregularly irregular rhythm
- TTE
- TEE (prior to cardioversion)
- exercise stress test (CAD)
- heart monitors
20
Q
labs for a.fib
A
- TSH
- CBC
- BMP
21
Q
goals of therapy for a.fib
A
- rhythm control
- decr risk of TIA/emboli
- rate control
- alleviate sx
22
Q
indications for urgent DC cardioversion for a.fib
A
- active ischemia
- unstable hemodynamics
- organ hypoperfusion
- severe manifestations of heart failure (pulm edema)
- WPW syndrome (delta waves)
23
Q
indications for non-urgent DC cardioversion fo a.fib
A
- new onset or newly recognized
- persistent a.fib who are limited by their sx
24
Q
indications NOT to DC cardiovert for a.fib
A
- minimally sxatic
- multiple co-morbidities
- pts unlikely to remain NSR
- 80+ y/o
- paroxysmal a.fib
25
Prior to _____ for a.fib, control _____ rate and provide _____.
Prior to cardioversion for a.fib, control ventricular rate and provide IV heparin.
26
patient presents with a.fib for less than 48 hrs, what do you do?
heparin + rate control then cardiovert
27
patient presents with a.fib for more than 48 hrs, what do you do?
Option 1: oral anticoags x3wk then cardiovert
| Option 2: TEE
28
patient presents with a.fib for more than 48 hrs and you've decided to get at TEE, what are you looking for and what do you do if you find it or not?
No thrombus ==> heparin + cardioversion
| Thombus ==> oral anticoags x3wks
29
patient presented 3 weeks ago with a.fib of more than 48hrs for which you got a TEE and saw a thrombus, now what do you do?
repeat TEE
- No thrombus ==> cardioversion
- thrombus ==> long term anticoags + NO cardioversion
30
complications of a.fib with rapid ventricular rate (150+ bpm)
- heart palpitations, fatigue, SOB, etc
- ischemia
- pulm edema
- tachycardia induced cardiomyopathy
31
components of the CHA2DS2-VASc
- CHF
- HTN
- Age
- DM
- Stoke
- vascular dz
32
pharmacologic tx of a.fib
- *Beta-blocker* (metoprolol)
- *CCB* (diltiazem)
- digoxin
- amiodarone
33
How is digoxin rx'd?
- with beta-blocker
| - loading + maintenance dose
34
What is the MC toxicity with amiodarone?
- pulm: chronic interstitial pneumonitits
35
anticoag for emboli formation
- warfarin (Coumadin)
- dabigatran
- rivaroxaban
- apixaban
36
When to bridge warfarin with heparin/LMWH
- not usually for a.fib
- recent/ongoing TIA/embolus
- known arterial thrombus
- current hospital stay
37
indications for hospitalization with a.fib
- immediate bridge anticoagulants
- ablation
- tx of other medical conditions
- management of rate/sick sinus syndrome
38
What are the indications for ablation therapy?
a.fib + WPW
39
definition of a. flutter
one ectopic foci produces electrical circuit that goes around the tricuspid valve
40
epidemiology/etiology of a.flutter
- less common than a.fib but can lead to it
- s/p antiarrhythmic rx for a.fib tx
- associated with LA enlargement
41
ventricular/atrial rate of a.flutter
- ventricular = ~150bpm
| - atrial = ~250-350 bpm
42
associated disorders of a.flutter
- hyperthyroidism
- heart failure
- obesity
- OSA
- sick sinus syndrome
- pericarditis
- pulm dz or embolism
43
clinical manifestations of a.flutter
- palpitations
- lightheadedness
- SOB
- tachycardia
- evidence of CHF
44
diagnostics of a.flutter
- EKG
- TTE
- TEE if preparing to cardiovert
- exercise stress
45
complications of a.flutter
- heart ischemia
- pulm edema
- tachycardia induced cardiomyopathy
- thromboembolism
46
treatment goals of a.flutter
- control ventricular rate
- convert to and maintain NSR
- prevent systemic embolism
47
treatment options of a.flutter
1. rate control
- more difficult than a.fib
- beta-blocker, CCB,digoxin, ablation
2. convert to NSR
- antiarrhythmics
3. anticoagulants
- recurrent a.flutter or a.fib after ablation
- indefinite w/ CHADS2 score = 1+
