Cardiology - Atrial Fibrillation

Question 1

Classifications of AFib?

Answer 1

#first-detected
#paroxysmal
#persistent (over 7 days)
#long-standing persistent (over 1 year)

Question 2

3 early tests in pt with new Afib?

Answer 2

#TSH
#Sleep apnea testing (if suggestive history)
#ECHO for valvular/structural heart disease

Question 3

Pt with new afib - decision made not to cardiovert - does the patient need IV anticoagulation?

Answer 3

#no IV AC needed (begin ORAL AC)
#

Question 4

Pt with new afib - decision made to cardiovert - need for anticoagulation if? How long to wait to cardiovert? Can cardiovert sooner if? How long to keep on AC if cardioversion successful?

Answer 4

Afib for more than 48 hours (or unclear duration)

3 weeks on AC; TTE negative for thrombus

4 weeks minimum

Question 5

Indication for immediate cardioversion regardless of how long pt has been in Afib?

Answer 5

Afib with 
#hypotension
#myocardial ischemia
#heart failure

Question 6

Acute cardioversion of atrial fibrillation should be synchronized to what? (why?)

Answer 6

R wave (avoid an “R-on-T” event and provocation of VF)

Question 7

Goal HR range in rate controlled afib?

Answer 7

60-110

Question 8

Acute IV drugs for rate control in symptomatic afib with RVR?

Answer 8

#metoprolol
#esmolol
#diltiazem
#verapamil

Question 9

Avoid calcium channel blockers in afib patients if?

Answer 9

LV dysfunction

Question 10

Digoxin especially good for rate control in patients with?

Answer 10

heart failure

Question 11

Treatment for preexcitated atrial fibrillation?

Answer 11

procainamide

Question 12

Pharmacologic cardioversion options for afib? (class and specific drugs)

Answer 12

Class IC agents (flecainide, propafenone)

Ibutilide (Class III)

Question 13

When use CHA(2)DS2-VASc?

Score that warrants AC?

Answer 13

CHADS2 score of 0 or 1

2+

Question 14

Conditions that require anticoagulation regardless of CHADS2(-VASc) score?

Answer 14

#mitral stenosis 
#rheumatic heart disease
#prior systemic embolism
#prosthetic heart valve
#left atrial appendage thrombus
#hypertrophic cardiomyopathy

Question 15

When to give warfarin instead of considering novel anticoagulants?

Answer 15

Valvular afib (defined as afib with mitral stentosis or mitral valve replacement)

Question 16

Bleeding risk of dabigatran (vs warfarin)?

Answer 16

#decreased stroke risk
#decreased intracranial bleeding
#higher risk of GI bleeding

Question 17

Bleeding risk of rivaroxaban (vs warfarin)?

Answer 17

#decreased intracrainal/fatal bleeding
#higher risk of GI bleeding

Question 18

Bleeding risk of apixaban (vs warfarin)?

Answer 18

#Decreased stroke risk
#decreased intracrainal bleeding
#Similar GI bleeding risks

Question 19

All novel anticoagulants are cleared by?

Answer 19

kidney

Question 20

treatment of patient with Afib and recent ACS?

If patient has stent placed?

Answer 20

low dose aspirin and anticoagulation

triple therapy with thienopyridine (plavix) for as short of a time as possible (6 months if DES)

Question 21

Cormorbidities in a patient with afib that needs more stringent rate control (HR 60-80 at rest)?

Answer 21

#tachycardia-induced cardiomyopathy
#heart failure
#LVEF under 40%

Question 22

In addition to rate control at rest, afib patients should also undergo? (options?)

Answer 22

Assessment of HR with activity

#ambulatory ECG monitoring
#stress test
#6-minute walk test.

Question 23

Patient who may benefit from pill-in-the-pocket approach?

Answer 23

#infrequent symptomatic afib
#no structural heart disease or conduction disease
#already taking AV nodal blocker

Question 24

patients who have refractory symptomatic atrial fibrillation despite antiarrhythmic drug therapy may benefit from? Reserve for which patients?

Answer 24

Cather ablation with pulmonary vein isolation

#early afib
#no LA enlargment

Question 25

Patient develops dyspnea months to years after afib ablation - consider?

Answer 25

pulmonary vein stenosis

Question 26

In patients with symptomatic atrial fibrillation who are undergoing cardiac surgery for other reasons, can qualify for this procedure?

Answer 26

Maze procedure

Question 27

Patients with refractory symptomatic tachycardia despite attempts at rate and rhythm control may be candidates for? If done, pt will need? Will they need to remain on anticoagulation?

Answer 27

AV node ablation pacemaker; yes