A Fib

Front 1

normal heart rate per minute?

Back 1

60-100 bpm

Front 2

normal sinus rhythm PR time?

Back 2

0.20 sec

Front 3

normal sinus rhythm QRS time?

Back 3

0.12 sec

Front 4

normal sinus rhythm QT time?

Back 4

0.44 sec

Front 5

A fib rate?

Back 5

atrial 300-600 bpm, ventricular 120-180bpm

Front 6

What can cause slow conduction through the AV node?

Back 6

digoxin, BB, CCB, people with AV nodal disease

Front 7

physical exam diag (not ecg) of a fib?

Back 7

fast heart rate without a correlation between auscultated apical heart rate and palpated wrist heart rate

Front 8

ECG results for a fib for P wave?

Back 8

400 to 600 bpm

Front 9

ECG results for a fib for QRS?

Back 9

100-160 bpm

Front 10

ECG results for a fib for rhythm?

Back 10

irregular

Front 11

ECG results for a fib for morphology?

Back 11

baseline undulation (wavy appearance), no P waves, QRS normal

Front 12

age group of highest incidence of a fib in US?

Back 12

>80

Front 13

incidence of a fib in caucasians vs AAs?

Back 13

AF x2 in caucasians compared to AAs

Front 14

Marshfield Clinic epidemiologic study?

Back 14

at 4 yrs, 2.4x risk of death in pts with a fib or a flutter

Front 15

EKG saw blade appearance =?

Back 15

atrial flutter

Front 16

Structural causes of a fib?

Back 16

rheumatic valvular disease, mitral stenosis

Front 17

clinical causes of a fib?

Back 17

htn, atherosclerosis, CHF, DM, pulmonary disease, cardiothoracic surgery, hyperthyroidism, age

Front 18

Modifiable risk factors for a fib?

Back 18

smoking, alcohol

Front 19

emerging risk factors for a fib?

Back 19

psych stress, elevated c-reactive protein, tall, metabolic syndrome/obesity, genetic predisposition

Front 20

What is lone AF?

Back 20

a fib without structural heart disease or any described factors

Front 21

ECG results for a fib for morphology?

Back 21

baseline undulation (wavy appearance), no P waves, QRS normal

Front 22

age group of highest incidence of a fib in US?

Back 22

>80

Front 23

incidence of a fib in caucasians vs AAs?

Back 23

AF x2 in caucasians compared to AAs

Front 24

Marshfield Clinic epidemiologic study?

Back 24

at 4 yrs, 2.4x risk of death in pts with a fib or a flutter

Front 25

EKG saw blade appearance =?

Back 25

atrial flutter

Front 26

Structural causes of a fib?

Back 26

rheumatic valvular disease, mitral stenosis

Front 27

clinical causes of a fib?

Back 27

htn, atherosclerosis, CHF, DM, pulmonary disease, cardiothoracic surgery, hyperthyroidism, age

Front 28

Modifiable risk factors for a fib?

Back 28

smoking, alcohol

Front 29

emerging risk factors for a fib?

Back 29

psych stress, elevated c-reactive protein, tall, metabolic syndrome/obesity, genetic predisposition

Front 30

What is lone AF?

Back 30

a fib without structural heart disease or any described factors

Front 31

ECG results for a fib for morphology?

Back 31

baseline undulation (wavy appearance), no P waves, QRS normal

Front 32

age group of highest incidence of a fib in US?

Back 32

>80

Front 33

incidence of a fib in caucasians vs AAs?

Back 33

AF x2 in caucasians compared to AAs

Front 34

Marshfield Clinic epidemiologic study?

Back 34

at 4 yrs, 2.4x risk of death in pts with a fib or a flutter

Front 35

EKG saw blade appearance =?

Back 35

atrial flutter

Front 36

Structural causes of a fib?

Back 36

rheumatic valvular disease, mitral stenosis

Front 37

clinical causes of a fib?

Back 37

htn, atherosclerosis, CHF, DM, pulmonary disease, cardiothoracic surgery, hyperthyroidism, age

Front 38

Modifiable risk factors for a fib?

Back 38

smoking, alcohol

Front 39

emerging risk factors for a fib?

Back 39

psych stress, elevated c-reactive protein, tall, metabolic syndrome/obesity, genetic predisposition

Front 40

What is lone AF?

Back 40

a fib without structural heart disease or any described factors

Front 41

What is silent AF?

Back 41

nonpharmacological conversion = cardioverters, pacemakers, catheter ablation, pharmacological converison; usually in pts >65

Front 42

In a fib, what is the hemodynamic compromise consist of?

Back 42

ejection fraction < 25%, reduced filling time and volume, oxygen delivery, and waste removal

Front 43

Potential AF complications?

Back 43

thromboembolic strokes (framingham study) and CHF (manitoba and renfrew studies)

Front 44

Goals in management of AF?

Back 44

control HR, convert to sinus rhythm, prevent reoccurences and complications, QOL

Front 45

Antiarrythmic drugs Vaughan-William classification I?

Back 45

na channel blocking agents

Front 46

Antiarrythmic drugs Vaughan-William classification II?

Back 46

BB

Front 47

Antiarrythmic drugs Vaughan-William classification III?

Back 47

K channel blocking agents

Front 48

Antiarrythmic drugs Vaughan-William classification IV?

Back 48

CCB

Front 49

According to Race II, what were the results?

Back 49

lenient rate control is non-inferior to strict rate control in a fib pts

Front 50

What were the results of Atrial fibrillation and congestive heart failure trial?

Back 50

rate control > rhythm control in outcomes

Front 51

Non-pharmacological management of AF?

Back 51

cardioversion, pace-maker, cardioverter implants, catheter ablation, maze surgery

Front 52

Types of cardioversion?

Back 52

electrical (dc current 50-100J) or pharmacological

Front 53

What are the pharmacological types of cardioconversion?

Back 53

-(type Ia)digoxin 0.25mg IV q6h to total dose of 1mg then procainamide po
-(type III) sotalol, amiodarone, ibutilide, dofetilide

Front 54

Outcome of RE-LY study?

Back 54

dabigatran approved for prevention of stroke or systemic embolism in pts with AF

Front 55

Dosing of dabigatran in AF pts?

Back 55

150mg bid or 75mg bid in pts with crcl 15-30ml/min

Front 56

Dosing for ibutilide in rhythm control?

Back 56

-<60kg = 0.01mg/kg over 10 min
->=60kg = 1mg over 10 min
-can do second dose if 1st not worked
-ecg monitor x 4h
-feeling of death and flatten ecg after infusion
-drug drug interaction with QT prolong drugs

Front 57

Dosing for dofetilide?

Back 57

0.25-1mg po qd;
-crck >60ml/min 500mcg bid
- 40-60 = 250mcg bid
- 20-39 = 125mcg bid
- <20 = NO

Front 58

QT contraindication for dofetilide?

Back 58

if greater than 440ms or 500ms for pts with conduction abnormalities

Front 59

Dosing of dronedarone?

Back 59

400mg bid with meals

Front 60

Contraindications of dronedarone?

Back 60

NYHA IV (EF <35%) or decompensated CHF in past 4 weeks

Front 61

MOA of dronedarone?

Back 61

sympatholytic, inhibits l-type Ca current, inward NA current and multiple K currents

Front 62

Drug drug interactions of dronedarone (multaq)?

Back 62

increase dig levels

Front 63

Economic burden of AF?

Back 63

6.65 billion for tx / yr