Mksap 16 Cardio Part 5

Front 1

RE-LY trial

Back 1

dabigatran was shown to be superior to warfarin in preventing ischemic and hemorrhagic stroke, with a reduced risk of life-threatening bleeding but a higher risk of gastrointestinal bleeding

Front 2

Rivaroxaban for Afib?

Back 2

approved for prevention of stroke and systemic embolism in atrial fibrillation. It is noninferior to warfarin for stroke prevention with no difference in major bleeding, but demonstrates a reduction in intracranial hemorrhage

Front 3

when should oral anticoagulation be interrupted in patients with Afib needing invasive procedures

Back 3

If the patient has a low short-term risk (CHADS2 score of 0-2) and the duration of interruption is less than 1 week, then bridging is not needed. If the patient has a higher short-term risk (CHADS2 score of 5-6, recent stroke, mechanical or rheumatic mitral valve) or if the interruption is more than 1 week, then use of a bridging agent should be considered more strongly

Front 4

resting heart rate goal for Afib

Back 4

<110 /min

Front 5

“pill-in-the-pocket” approach for patients with symptomatic paroxysmal Afib

Back 5

short-acting B-blocker or calcium blocker 30 minutes before flecainide or propafenone

Front 6

anticoagulation after afib ablation

Back 6

continue warfarin x 2-3 months, thereafter guided by CHADS2 score

Front 7

Nonpharmacologic strategies for Afib

Back 7

Afib ablation, AV node ablation, maze surgery

Front 8

involves several incisions or ablations in the right and left atria to interrupt potential reentrant pathways required for atrial fibrillation maintenance

Back 8

Maze surgery

Front 9

causes of bradycardia

Back 9

dysfunction of sinus node, AV node, or His-Purkinje system; + reversible causes KIDLAT! (hyperK, drugs, Lyme, Thyroid disease)

Front 10

underlying cause of pathologic sinus bradycardia in most patients

Back 10

fibrotic replacement of the sinus node associated with aging (other causes - infarction, surgery damage, infiltrative processes, inc vagal tone, meds, genetic diseases)

Front 11

pathology in second degree AV blocks

Back 11

Mobitz type 1 is disease within AV node, type 2 more worrisome suggesting His Purkinje disease; HR of progressing to CHB

Front 12

two or more nonconducted P waves occur for each QRS complex

Back 12

Advanced second-degree heart block, or high-grade heart block

Front 13

pathology in CHB

Back 13

conduction block in His bundle or below

Front 14

treatment for symptomatic sinus bradycardia or heart block without reversible causes

Back 14

permanent pacemaker

Front 15

common causes of sinus tachycardia

Back 15

pain, fever, anxiety, anemia; in younger, SVTs, in older, AFib, aflutter, Vtach; any age - PACs and PVCs

Front 16

Class II and Class IV antiarrhythmics are contraindicated in

Back 16

decompensated systolic HF or WPW syndrome

Front 17

Class IC antiarrhythmics are contraindicated in

Back 17

after MI (increases risk of polymorphic VT)

Front 18

Class III agents (not amio)initiated, waht to watch out for?

Back 18

start in-patient over 3 days to monitor for torsades, if QTc >500 or increases by >15% or 60msec, decrease or discontinue dose

Front 19

S/E of amiodarone

Back 19

thyroid dysfunction, liver toxicity, pulmonary fibrosis, and skin hypersensitivity

Front 20

advantages of the newest antiarrhythmic agent dronedarone

Back 20

reduce hospitalization or death in Afib atrial or flutter, and less side effects cf amio

Front 21

S/E of dronedarone

Back 21

increased crea but does not change GFR; do not use in NYHA II or III with recent decompensation or Class IV; should not be used as rate control agent in those with permanent AFib

Front 22

MOA of adenosine

Back 22

blocks the A1 receptors in the AV node and can terminate reentrant SVTs

Front 23

what is paroxysmal, persistent and permanent Afib

Back 23

terminates on its own - paroxysmal; >7days - persistent; continuous and cardioversion has failed or no longer attempted - permanent

Front 24

atrial fibrillation occurs in the absence of structural heart disease in a patient younger than 60 years

Back 24

lone Afib

Front 25

Afib >48 hours, two strategies before cardioversion

Back 25

warfarin x 3 weeks then cardiovert or full anticoagulation then TEE, if NEG, then cardiovert

Front 26

post cardioversion of Afib, next step?

Back 26

4 weeks of warfarin with goal INR 2-3 because atrium is stunned

Front 27

when should cardioversion be done emergently in Afib?

Back 27

hypotension, angina or heart failure

Front 28

goal INR in patients with rheumatic mitral stenosis and atrial fibrillation

Back 28

2-3

Front 29

If a mechanical heart valve is present in a patient with atrial fibrillation, the level of anticoagulation is based on the type of valve, with a minimum INR of

Back 29

2.5

Front 30

Prasugrel in Afib?

Back 30

There is currently no role for prasugrel for stroke prophylaxis in atrial fibrillation

Front 31

RE-LY trial

Back 31

dabigatran was shown to be superior to warfarin in preventing ischemic and hemorrhagic stroke, with a reduced risk of life-threatening bleeding but a higher risk of gastrointestinal bleeding

Front 32

Rivaroxaban for Afib?

Back 32

approved for prevention of stroke and systemic embolism in atrial fibrillation. It is noninferior to warfarin for stroke prevention with no difference in major bleeding, but demonstrates a reduction in intracranial hemorrhage

Front 33

when should oral anticoagulation be interrupted in patients with Afib needing invasive procedures

Back 33

If the patient has a low short-term risk (CHADS2 score of 0-2) and the duration of interruption is less than 1 week, then bridging is not needed. If the patient has a higher short-term risk (CHADS2 score of 5-6, recent stroke, mechanical or rheumatic mitral valve) or if the interruption is more than 1 week, then use of a bridging agent should be considered more strongly

Front 34

resting heart rate goal for Afib

Back 34

<110 /min

Front 35

“pill-in-the-pocket” approach for patients with symptomatic paroxysmal Afib

Back 35

short-acting B-blocker or calcium blocker 30 minutes before flecainide or propafenone

Front 36

anticoagulation after afib ablation

Back 36

continue warfarin x 2-3 months, thereafter guided by CHADS2 score

Front 37

Nonpharmacologic strategies for Afib

Back 37

Afib ablation, AV node ablation, maze surgery

Front 38

involves several incisions or ablations in the right and left atria to interrupt potential reentrant pathways required for atrial fibrillation maintenance

Back 38

Maze surgery