Term
| atrial fibrilation is defined as what |
|
Definition
| supreaventricular tachycardia with irregular rhythm. |
|
|
Term
atria rate vs. ventricular rate-
what causes this difference? |
|
Definition
atria- 400 bpm
ventricle- 120 ;
AV node |
|
|
Term
what is the definition of Rapid ventricular response?
what are symtpoms? -4 |
|
Definition
ventricular heart rate >100;
palpitations, HR increase, PE, ADHF |
|
|
Term
| atrial fibrilations are commonly found with what other conditons-3 |
|
Definition
|
|
Term
| what is a long term consequnce of RVR |
|
Definition
|
|
Term
| what are emergency symptoms from Afib-4 |
|
Definition
| angina/MI, PE w/ hypoxia, HTN<90/60, HR>150 |
|
|
Term
High _ tone is a cause of A fib
what are some causes of this? -5 |
|
Definition
adrenergic
hyperthyoid, caffeine, ephedrine, sepsis, ionotropes |
|
|
Term
| Drug abuse/withdrawal can cause what |
|
Definition
|
|
Term
| causes of atrial distension- -5 |
|
Definition
| pulmonary disease, HTN, valve disease, cardiomyopathy, ischemia |
|
|
Term
| what do you do to see if the patient needs anticoag |
|
Definition
|
|
Term
| what are the two different options for rhythm and rate control |
|
Definition
switch to sinus rhythm
leave Afib and control to prevent complications |
|
|
Term
when are parenteral anticoags considered in patients?
when should they always be started? |
|
Definition
hopsitalized for more than 48 hrs for A fib
- undergoing cardioversion |
|
|
Term
| if the duration of the Afib has been less than 48 hrs what is the protocol concerning antigcaog- |
|
Definition
| heperanoid + electrical cardiovert |
|
|
Term
| if the duration of the Afib has been more than 48 hrs what is the protocol concerning antigcaog- |
|
Definition
| anticaog for 3 weeks + TEE |
|
|
Term
what are meanings for :
C
H
A
D
S2 |
|
Definition
C-congestive HF/LVD
H-HTN
A- Agee>75
D- diabetes
S- stroke/TIA (2 points) |
|
|
Term
what is low risk score for CHADS2?
what are the treatment options-2 |
|
Definition
0 points
-no therapy or
ASA 75 mg |
|
|
Term
What is moderate-high risk for CHADS2?
what are the 3 diff treatment options? |
|
Definition
1+ points;
-anticaog
-ASA 81 mg + plavix
-ASA 75-325 mg |
|
|
Term
what is the dose for dabigatran?
rivaroxiban
apixaban |
|
Definition
|
|
Term
| what is the dose adjustment for dabigatran |
|
Definition
|
|
Term
| what is the dose adjustment for rivaroxiban |
|
Definition
|
|
Term
| what is the dose adjustment for apixiban |
|
Definition
Sr Cr >1.5 + either:
age>80 or weight <60 kg
2.5 BID |
|
|
Term
| what antiarrthymic medicine has an interaction with the anticoags |
|
Definition
|
|
Term
| what drugs have interacitons with all anticoags? |
|
Definition
| amiodarone, azoles, rifampin, protease inhibitors |
|
|
Term
| 1st option to prevent cardio stroke are anticoags, if the patient has bleeding risk factors tho what is an alternative? |
|
Definition
|
|
Term
| you can chose to control rate or rhythm- what is the rate treatment option? |
|
Definition
| keep Afib, control ventricular heart rate |
|
|
Term
| you can chose to control rate or rhythm- what is the rhythm treatment option? |
|
Definition
|
|
Term
| how do you normally convert a aperson to normal sinus rythm the first time? if the A fib reappaears then what is the treatment? |
|
Definition
electrically (DCC)
DCC and add antiarrthym class 1 or 3 |
|
|
Term
| when is anticoag treatment need for rate/rhythm control? |
|
Definition
|
|
Term
patient presents with new onset A fib- what is 1st line treatment?
what is the only reason you do the other option? |
|
Definition
acute rate control
only do rhythm 1st if have emergency symtpms (shock, HF, etc.) |
|
|
Term
| if the patient is put on rhythm control due to emergency symtpoms what is the treatment- |
|
Definition
IV heparin +
electrical cardioversion |
|
|
Term
| if acute rate control doesnt work and patient is put on rhythm control- what determines the treatment options- |
|
Definition
| if had A fib< or > 48 hrs |
|
|
Term
| if had A fib < 48 hrs and rythm control- what is the treatment |
|
Definition
IV heparin
electracl cardiovert |
|
|
Term
| if had A fib >48 hrs and put on rhythm control what is the treatment process -3 things |
|
Definition
- anticaog x 3 wks
-then cardiovert + TEE
-then anticoag for 4 wks |
|
|
Term
options for acute rate control:
w/o HTN/ADHF:
w/ ADHF/HTN:
w/ either of these what also needs to e started? |
|
Definition
BB or Non-DHP CCB
amiodarone or digoxin
anticoag |
|
|
Term
| what needs to be done in order to start chronic rate control at home? -2 |
|
Definition
change to PO formulations
continue anticoag |
|
|
Term
| for acute rate control- what is the target you titrate agents to |
|
Definition
|
|
Term
fro chronic rate control- what are the targets for:
patient with HF-
Patient w/o HF- |
|
Definition
|
|
Term
what are the first line agents for rate control?
what are the times when you should use an alternative for Acute AF? |
|
Definition
BB or Non CCB;
hypotensive/ADHF |
|
|
Term
| whcih beta blocker is onvly available in IV |
|
Definition
|
|
Term
| when are BB used over Non CCBs in rate control |
|
Definition
| if patient has chronic systolic HF |
|
|
Term
for rate control, amiodarone vs digoxin:
which is 2nd line option for acute AF?
which for chronic AF? |
|
Definition
|
|
Term
| what is the chronic regimen for amiodarone-2 options |
|
Definition
200 mg daily
100 if elderly or underweight |
|
|
Term
| what are the major side effects of amiodarone-7 |
|
Definition
thyroid (hypo/hyper)
cornea deposits
skin discolor
QT elongation
pulomnary disease
optic neuropathy
hepatox |
|
|
Term
| avoid use of Non-CCBs in acute and chronic AF if patient has what type of HF |
|
Definition
|
|
Term
| when do you initate long term rhythm control meds |
|
Definition
-if rate control doesnt work
-return of AF after cardioversion |
|
|
Term
| what antiarrthymic classes are used for rhythm control? |
|
Definition
|
|
Term
what is the class agent that can be converted to outpatient?
which is the one that cant be converted at all? |
|
Definition
|
|
Term
| which is the class 3 agent not used for maintenance? |
|
Definition
|
|
Term
| if the patient has a prolonged QT- what class 3 agent can still be used |
|
Definition
|
|
Term
| contraidnications for amiodarone-2 |
|
Definition
|
|
Term
| which is the only class 3 agent that probably wont cause torsades de pointes |
|
Definition
|
|
Term
| what are side effects of sotalol-2 |
|
Definition
|
|
Term
| what are side effects of ibutilide-2 |
|
Definition
|
|
Term
| what are the side effects of Dofetilide-2 |
|
Definition
|
|
Term
| what are the class 1 agents |
|
Definition
disopyramide
fleicainide
propafenone |
|
|
Term
| which class 1 agents can be converted to outpatient-2 |
|
Definition
|
|
