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16 Cards in this Set
- Front
- Back
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Who is at risk for Atrial Fibrillation?
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increasing age >60, men, have underlying valvular disease or heart failure.
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What symptoms and signs are suspected in patient with Atrial Fibrillation?
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palpitation, SOB, chest pain, malaise. However, some old pt may be asymptomatic. HR irregularly irregular
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What is the role of H&P in pt with Atrial Fibrillation?
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Hx of HTN, duration, HF, cardiac surgeries, structural heart disease, hyperthyroidism, use of adrenergic drugs.
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What is the key feature on EKG in pt with Atrial Fibrillation?
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Ther is no P waves.
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What are the classifications of Atrial Fibrillation?
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1. Paroxysmal: episode terminate within 7 days. (spontaneously)
2. Persistent: lasting >7 days required intervention to restore to SR. 3. permanent: failure to restore despite intervention. OR not been attempted. |
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What studies to obtain in pt with newly dx Atrial Fibrillation?
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TSH, renal/hepatic panel, TTE to start with.
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What underlying conditions should you look for in pt with Atrial Fibrillation?
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80% of AF have structural heart disease. HTN, MI, PE, OSA, obesity
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What are the goals for treating Atrial Fibrillation?
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1. reduce symptoms.
2. prevent thromboembolism 3. prevent cardiomyopathy. |
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When should one consider immediate cardioversion in Atrial Fibrillation?
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New onset Atrial Fibrillation of < 48 hrs duration
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Should you considered rate or rhythm control in Atrial Fibrillation?
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According to the AFFIRM trial, no improvement in all causes of mortality, stroke, HF or quality of life with rhythm control. (the mean age was 69)
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What rate control in pt with rapid Atrial Fibrillation?
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A strategy of lenient rate control <=110 with strict rate control <=80 found no advantage. Use BB (metoprolol, seletive B1 antagonist), CCB
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What strategy for rhythm control in younger pt with Atrial Fibrillation?
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DC cardioversion when hemodynamically unstable. Rhythm control for symptoms control.
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When is anticoagulation indicated for patient with Atrial Fibrillation?
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pt with paroxymal, persistent and permanent AF have same indication for anticoagulation. Use the CHADS2 to further evaluate the need.
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What is CHADS2?
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Criterias for anticoagulation.
C-CHF, H-HTN, A-Age>75, D-DM, S-stroke or TIA (gets 2 points) |
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What anticoagulation should be use in Atrial Fibrillation?
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Warfarin is the 1st choice, keep INR 2-3, if pt have posthetic valves, keep INR 2.5-3.5. Newer drug on market now is dabigatran 150mg bid
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When should cardioversion be attempted if AF >48 hrs?
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anticoagulation for 4 week. alternative is to do TEE to eval for clots at the left atrial appendage.
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