B4-001 Big Case: Tachycardia Flashcards
(46 cards)
maximum predicted HR
220-patients age
3 consecutive beats greater than >100 bpm
tachycardia
sequence of excitation in the heart
- SA node
- atrial muscle
- AV node
- common bundle
- bundle branches
- purkinje fibers
- ventricular muscle
what could a narrow QRS indicate?
- atrial tissue only
- sinus tachycardia
what could a wide QRS indicate?
- ventricular tachycardia
- any narrow complex tachycardia with aberrant conduction
irregularly irregular without P waves
atrial fibrillation
most common sustained arrhythmia, increases with age
a fib
cardiac causes of a-fib
- hypertension
- CAD
- heart failure
- cardiomyopathy
- valvular disease
- arrhythmias
non-cardiac causes of a-fib
- sleep apnea
- obesity
- hyperthyroidism
- drugs
- electrocution
- pneumonia
- pulmonary embolism
- alcohol (holiday heart syndrome, dose dependent)
“A-fib begets a-fib”
progression of a-fib
paroxysmal, persisent, longstanding persistent, permanent
what studies should always be done to evaluate a-fib?
- 12 lead ECG
- labs
- TTE
causes of valvular atrial fibrillation
3
- rheumatic mitral stenosis
- moderate-to-severe mitral stenosis
- mechanical valve
ABCs of A-fib management
A: anticoagulation/avoid stroke
B. better symptom control
C. cardiovascular risk factors and comorbidities
score system used to evaluate risk of thromboembolism
CHA2DS2-VASc
score system to evaluate risk of bleeding
HAS-BLED
most concerning complication of a-fib?
increased stroke risk
from blood pooling and forming clots
most concerning complication of a-fib?
increased stroke risk
from blood pooling and forming clots
patients with a-fib have an increased risk of?
[4]
- ischemic stroke (5x)
- heart failure (3x)
- dementia (2x)
- death (2x)
why are a-fib related strokes worse than other strokes?
- increased 30 day mortality (almost 2x)
- more likely to recur
- more severe functional deficits
oral anticoagulation is strongly recommended for a CHA2DS2-VASc score greater than
- 2 for men
- 3 for women
factors that have a CHA2DS2-VASc value greater than 2
2
- age >75
- hx of stroke, TIA, or embolism
HAS-BLED score greater than 3
- warrants additional monitoring
- address modifiable bleeding risks
modifiable bleeding risks
5
- uncontrolled hypertension
- abnormal renal function
- labile INR (<60% in therapuetic range)
- antiplatelets or NSAID use
- greater than 8 drinks per week
only anticoagulation for valvular a-fib
warfarin
