Term
Each year approximately _________
people in the US experience a new or recurrent stroke? |
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Definition
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Term
| Overall, ischemic strokes are the most common type of stroke and AF is responsible for _____________% of all ischemic strokes? |
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Definition
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Term
1.2 Epidemiology:
How many people in US had AF? |
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Definition
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Term
| Prevalence of Af increases with increasing age. What is prevalence by age group |
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Definition
0.1%among people <55
9.0% in people Also greater in every age group in men vs women. |
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Term
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Definition
- Increasing AGE
- diabetes
- hypertension
- congestive heart failure
- Left Ventricular Hypertrophy
- MI
- Valvular Heart Disease
- obesity
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Term
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Definition
- Primary - in which af spontaneously occurs and is not caused by another disease or injury
- secondary - which has an acute and potentially reversible cause such as hyperthyroidism
- non valvular, in which disease of the heart valves is not involved
- valvular af in which dysfunctional heart valves affect blood flow
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Term
| acc/aha/esc classification of af |
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Definition
First Detected can be either paraxysmal or persistent (about 40% are paroxysmal)
Recurrent >/= 2 episodes either paroxysmal or persistent
Paraxysmal - Self Terminating Terminate spontaneously
Persistent -Not self -terminating lasting greater than 7 days
Permanent - AF of long duration, cardioversion has not been indicated or >/= attempts have failed to restore sinus rhythm
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Term
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Definition
| individuals younger than 60 years who do not have clinical or echocardiographic evidence of cardiopulmonary disease including hypertension. |
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Term
Electrophysiologic mechanisms
the path of a normal electcrical impulse |
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Definition
- the impulse termed an action potential, is initiated by autorhythmic fibers in the sinoatrial (SA Node)
- it then spreads rapidly throughout the atria and reaches the atrioventricular (AV) which is the impulse gateway between the atria and the ventricles ---at this point the atria contract
- the av node transmits the impulse to the right and left bundle branches, the purkinje fibers and finally to the ventricular myocardium ----at this point the ventricles contract
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Term
| What happens to electrical impulse in AF? |
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Definition
| the source of the impulse and or its atrial pathway are abnormal. That is, the electrical impulses normally generated by the SA node are replaced by multiple coexisting impulseds that randomly roam and create new impulses in the atria causing rapid and irregular atrial contraction. These impulses are transmitted irregularly to the ventricles, resulting in an irregular ventricular contraction and a fast and irregular heart rhythm. |
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Term
| ectopic stimulus or stimuli |
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Definition
an abnormal impulse that comes from a location outside the SA node. The most common source is the pulmonary veins, which enter teh ehart at the left atrium. |
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Term
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Definition
| Common symptoms are: dizziness, chest palpitations, chest pain, weakness, fatigue, frequent urination, shortness of breath, anxiety |
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Term
| What are the cornerstones of therapy for Afib and how many people are predicted will have Afib in 2050 |
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Definition
| What are the cornerstones of therapy for Afib and how many people are predicted will have Afib in 2050 |
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Term
| What are the risk factors for Afib |
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Definition
| ? The answer is advanced age, heart disease (primarily chf), HTN, chronic conditions i.e thyroid problems and sleep apnea, Alcohol, family history, obesity, diabetes, high dose steroid therapy, extreme stress or fatigue, and viral infections. |
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Term
| What is the basic diagnostic process for Afib? |
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Definition
The basic diagnostic process for AF includes:
– patient history and physical exam: identifies precipitants, risk factors, and potentially reversible
causes; characterizes the pattern of arrhythmia
– blood tests for thyroid, renal, and hepatic function, electrolytes, calcium
– 12-lead electrocardiogram (ECG): ECG evidence is required for the definitive diagnosis of AF; ECG shows
an absence of P waves; instead there are multiple tiny fibrillatory waves; QRS waves are irregularly timed
• for some patients, Holter monitoring or event recorders may be necessary (such as for patients
who may have paroxysmal AF)
– transthoracic echocardiogram (TTE): a noninvasive technique that provides images of the heart
and its movements
• Additional testing may be required in some patients, such as transesophageal echocardiography, to
better identify a thrombus |
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Term
| What are the 4 classes of agents in the Vaughan-Williams classification? |
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Definition
Class II - Beta Blockers (example metroprolol, atenolol and carvedilol) and Class IV non-DHP calcium channel blockers are used for RATE control.
Class I sodium channel blockers (Flecainide 1c slow), Procainamide 1A Intermediate, 1 b Lidocaine rapid) and class III (Potassium Channel BLockers) ie amiodarone ibutilide) are RHYTHM agents
- class I and class III agents have a number of noncardiac and cardiac adverse effects (including Proarrhythmia)
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Term
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Definition
quinidine
Procainamide
disopyramide
for ventricular arrhythmias |
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Term
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Definition
lidocaine
phenyton,
mexiletine
tocainide |
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Term
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Definition
Intermediate
Procainamide
Quinidine
Disopyramide |
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Term
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Definition
Rapid acting
Lidocaine
Mexiletine |
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Term
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Definition
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Term
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Definition
Metropolol
Atenolol
Carvedilol
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Term
Class III
K Channel Blockade
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Definition
Amiodarone
Sotalol
Dofetilide
Ibutilide
Bretylium |
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Term
Class IV
Ca 2 Channel BLockade
calcium channel blockers |
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Definition
Non-dihydropyridine
diltiazem
verapamil
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Term
The overall goals of treatment for AF include: |
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Definition
– regaining a normal heart rhythm (normal sinus rhythm)
– controlling the heart rate
– preventing thromboembolism, thus reducing the risk of stroke |
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Term
| What are the approved agents for stroke prophylaxis in patients with Afib? |
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Definition
– warfarin: a vitamin K antagonist; most commonly used oral anticoagulant, but in clinical practice
it is difficult to achieve and maintain the proper balance between anticoagulant effect and risk
for bleeding with this drug
– aspirin: antiplatelet agent considered to have only modest protection against stroke and is
recommended as an option for prophylaxis in patients with AF who are at low or moderate risk
of thromboembolism
– dabigatran etexilate (Pradaxa®): an oral direct thrombin inhibitor approved to reduce the risk of
– rivaroxaban (Xarelto®): an oral factor Xa inhibitor recently approved to reduce the risk of stroke
and systemic embolism in patients with nonvalvular AF |
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Term
Describe the 3 different types of Afib, based on how long a patient has had it?
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Definition
Paroxysmal-symptoms terminate spontaneously |
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Term
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Definition
| symptoms continue longer than 7 days |
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Term
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Definition
symptoms continue beyond one year or cardioversion is either tried and failed or is not an option. |
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Term
| What is the definition of Afib (how is it characterized)? |
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Definition
Afib is a type of arrhythmia that is characterized by disorganized, rapid, and irregular
contractions in the atria that cause irregular and often rapid contractions of the ventricles. |
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Term
| Strategies for rhythym control |
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Definition
Pharmacologic maintenance of normal sinus rhythm- AAD’s can be administered to maintain normal sinus rhythm and the selection of AAD’s depends on comorbidities and treatment guidelines.
Cardioversion-converts AF to normal sinus rhythm by using either: Direct electrical current, or Pharmacologic-high doses of certain Anti-arrhythmia Drugs (AAD’s).
Ablation of ectopic stimuli-If AAD’s are ineffective, ablation of the source of the ectopic stimuli can be performed with either radiofrequency or cryotherapy. Most common source of ectopic stimuli is the pulmonary veins.
Other surgical procedures-When ablation procedures are ineffective, the Maze procedure is an option. This is open-heart surgery performed while a patient is on cardiopulmonary bypass, in which incisions are made in the heart to cause scar tissue, essentially directing the impulses from the SA node to prevent reentrant circuits from forming.
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Term
| What are some specific strategies doctors use for heart rate control? |
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Definition
One of the first strategies for most patients is rate control; while criteria for target heart rate vary
with age, they usually involve heart rates of 60 to 80 bpm at rest and 90 to 115 bpm during
moderate exercise
– beta-blockers, non-DHP calcium channel blockers, and digoxin are pharmacologic options
– ablation of the AV node and implantation of a pacemaker can also control rate |
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