L7: Arrhythmia - Pt 3 Flashcards
(54 cards)
1
Q
Incidence of AFib
A
- Most commonly seen narrow complex arrythmia.
- Most common irregularly irregular rhythm
- Affects more than 10% of age >80.
- Men > Women
2
Q
Def of AFib
A
- Multiple impulses from different areas move toward the AV node.
- Produce an irregular ventricular response
3
Q
Rate in AFib depends on ……..
A
No. of impulses conducted
4
Q
Why is AFib Significant?
A
5
Q
Classifcation of AFib
A
6
Q
Etiology of AFib
A
7
Q
Symptoms of AFib
A
8
Q
Duration of AFib
A
Variable
9
Q
Pulse in AFib
A
100-180 / min
10
Q
Neck Veins in AFib
A
- Absent A wave
- v wave due to TR
11
Q
Heart Sounds in AFib
A
Variable S1
12
Q
Carotid Massage in AFib
A
Gradual slowing of the VENTRICULAR RATE rate
13
Q
INVx for AFib
A
14
Q
Management of AFib
A
15
Q
AAFP/ACP Recommendations on 1st diagnosed episode of AF
A
16
Q
TTT of AFib
- Reversion to NSR
A
17
Q
TTT of AFib
- Methods of Reversion to NSR
A
18
Q
TTT of AFib
- Indications of Reversion to NSR
A
19
Q
TTT of AFib
- Precaution While Reversion to NSR
A
20
Q
TTT of AFib
- Control of Ventricular Rate
A
by B blocker, Ca channel blocker or Digitalis.
21
Q
TTT of AFib
- prevention of thromboembolism by anticoagulants
A
22
Q
Rhythm Control in AFib
- Methods
A
- Synchronized DC cardioversion
- pharmacologic cardioversion
23
Q
Rhythm Control in AFib
- How to choose Method?
A
- If unstable → DC cardioversion
- If stable and correction of underlying problem does not help → DC or Drugs
24
Q
Rhythm Control in AFib
- Anticoagulation
A
25
Indication of Anticoagulation in **AFib**
26
Duration of Anticoagulation in **AFib**
27
Compare Between DC & Pharmacologic Drugs in Rhythm Control in Terms of
- Success
- Methods
28
Maintenence of **NSR**
29
Maintenence of **NSR**
- Incidence
Only 20-30 percent of patients stay in sinus for > 1 year.
30
Maintenence of **NSR**
- Methods
31
Maintenence of **NSR**
- Drugs
Amiodarone
32
Amiodarone in Maintenence of **NSR**
- Value
good
33
Amiodarone in Maintenence of **NSR**
- Indications
used in patients with bad heart disease
- (significant systolic dysfunction, hypertension with LVH)
34
Amiodarone in Maintenence of **NSR**
- SE
35
Rate Control in **AFib**
36
Rate Control in **AFib**
- Methods
slowing AV conduction
- (beta blockers, calcium channel blockers, dig, amio)
37
Rate Control in **AFib**
- DOC in each Case
**Digoxin** → only in hypotension and Heart Failure
**Amiodirone** → rarely but effective
38
**Anticoagulation during reversion to NSR**
39
**Anticoagulation during reversion to NSR**
- Indications
40
**Anticoagulation during reversion to NSR**
- Duration
41
**Anticoagulation during reversion to NSR**
- Consider chronic anticoagulation for those with high risk for reversion.
...
42
Why chronic anticoagulation once cardioverted and NSR?
43
**Anticoagulation in Chronic AF**
44
**Anticoagulation in Chronic AF**
- Incidence of Stroke with AF
Stroke associated with AF is 3-5% / year without anticoagulation
45
**Anticoagulation in Chronic AF**
- Aspirin Vs Warfarin
Many factors determine ASA vs warfarin
46
**Anticoagulation in Chronic AF**
- Estimation of Risk of Stroke
Estimated risk of stroke is determined with a **CHADS2 score**
47
**Anticoagulation in Chronic AF**
- TTT Acc to Score
-T herapy determined with this scale of 1-6. (CHF, HTN, Age, DM, Secondary prevention)
- 0 -----> **ASA**, because of 0.5 /year w/o coumadin
- 1 - 2 ----> **intermediate risk**
- >3 → **warfarin**
**P.S. → ASA usually added to warfarin**
48
Managment of **New Onset Atrial Fibrillation**
49
Managment of **New Onset Atrial Fibrillation**
- ER Reversion
50
Managment of **New Onset Atrial Fibrillation**
- Hospitalizataion
51
Managment of **New Onset Atrial Fibrillation**
- Search for Cause
52
Managment of **New Onset Atrial Fibrillation**
- Indications for immediate cardioversion
1. Active ischemia
2. Hypotension
3. Severe HF
53
Managment of **New Onset Atrial Fibrillation**
- Start Rate Control
54
Managment of **New Onset Atrial Fibrillation**
- Elective Cardioversion
