Cardiology arrhythmias & valvular Flashcards
(19 cards)
PIRATES mnemonic for afib
- Pulm disease (COPD, PE, pneumonia)
- ischemia & infections
- remodelling of heart
- alcohol
- thyrotoxicosis
- electrolytes low (K, Mg)
- sleep apnea and deprivation
Types of afib
Valvular afib - associated with mechanical valve or severe mitral stenosis
non-valvular
Paroxysmal - lasting 30+seconds but terminates on own or with intervention within 7d
Persistent - lasting 7+ days but <1 year
Permanent - lasting 1+ year and agreeing not to convert to NSR
what is Afib
an SVT with uncoordinated atrial activity
cardiac risk factors for afib
HTN, HFrEF, valvular dz, congenital valvular dz, cardiomyopathy
non cardiac risk factors for afib
thyroid dz, OSA, obesity, excessive alcohol
causes of secondary fib
MI, pericarditis, COPD, PE, pneumonia, thyrotoxicosis, infection, sepsis, acute alcohol, cocaine, sleep deprivation, stress, physical exertion
PIRATES
symptoms of afib
- may be asymx
- palps
- fatigue, weariness, reduced exercise capacity
- syncope/dizziness
- chest pain
- SOB
complications:
- stroke
- HF
- tachy - cardiomyopathy
thromboembolic risk factors
CHADs-65 score
CHF
HTN
Age > 65
DM
Prior Stroke +2
1+ = anticoagulant
Bleeding risk factors
HAS BLED
HTN > 160 SBP
Abnormal renal/liver
Stroke hx
Bleeding history/predispo
Labile INRs
Elderly
Drugs (antiplt, NSAIDs), alcohol
complications of AFIB
- Heart failure
- Stroke
- dilated cardiomyopathy from chronic tachy
in office, investigating afib
symptoms (SOB, palps, fatigue, syncope, CP)
pulse + BP machine will show if irregular
order ECG and labs
- CBC (anemia & infection)
- TSH
- Electrolytes (CMP)
- LFTs
- Cr
- Coagulation
- A1c and lipids - risk stratify
order echo
**if can’t capture on ECG, try Holter
**consider stress test if brought on by activity and sleep study (OSA is high risk)
what investigations will you order for AFIB
ECG or Holter
labs:
- CBC (anemia & infection)
- TSH
- Electrolytes (CMP)
- LFTs
- Cr
- Coagulation
- A1c and lipids - risk stratify
Echo
+Stress test
+Sleep study
Approach to managing afib in clinic
ECG diagnosis
CHADS-65 score, anticoagulant if 1+
rate control with BB, CCB, Dig
if ineffective or young/first episode, consider rhythm control & referral to cardio
ER management of unstable AFIB
if unstable (hypotensive, signs of MI or pulm edema) you will give OAC and cardiovert immediately, anticoagulant for 4 weeks after
ER management of afib
Depends on stability, if unstable you cardiovert.
If stable, depends on time
- if non-valvular <48h onset and no stroke in <6months & CHADS score 1 or less, can cardiovert
- if NVAF > 48h onset or CHADS score 2+, need to anti-coag for 3 weeks, do TEE and then cardiovert
- valvular AF you will do elective cardioversion
Anticoagulate for 4 weeks after procedure, after that depends on CHADS score
Pill in pocket approach
If they have paroxysmal and rare (1-2 occurrences a year), can give propafenone and metoprolol but first use has to be monitored by telemetry x 6 hours
in what situation is rhythm control preferred?
- if it is a recent onset <12 months
- young patient
- multiple recurrences
- extreme reduction in QOL
- very symptomatic
options for rhythm control
pharmacological - amiodarone, sotalol, flecainide, propafenone
electrical
options for rate control
beta blocker, CCB, digoxin
