Atrial Arrhythmias Practice Flashcards

Practice flashcards covering atrial arrhythmias, stroke risk stratification, anticoagulation dosing, and rate versus rhythm control strategies based on the provided lecture notes.

What is the most common sustained cardiac arrhythmia?

Atrial fibrillation

How much does a patient with AF is at risk at stroke?

> 5x

What are the re-entry mechanism?

Aflutter & AF

Which arrhythmia is characterized by a single dominant reentrant wavelet?

Atrial flutter

Which arrhythmia is characterized by multiple reentrant loops?

Atrial fibrillation

What can cause atrial distension?

myocardial infarction, valvular heart disease, congenital abnormalities

List four high adrenergic states mentioned as causes of AF and Atrial flutter.

Thyrotoxicosis, surgery, alcohol withdrawal, & sepsis

In Atrial Fibrillation, what is the typical atrial rate in beats per minute (bpm)?

350-450 bpm

What originates from many atrial foci firing at rapid rates?

Atrial fibrillation

Which originates from a single ectopic focus?

Atrial flutter

What is the typical rate of firing in Atrial flutter?

220-350 bpm

What specific EKG pattern is characteristic of Atrial flutter?

Saw tooth pattern

In Atrial flutter, which conduction ratios are commonly seen through the AV node to the ventricles?

2:1, 3:1, or 4:1

What is the presentation of AF?

Fatigue, palpitations, shortness of breath, hypotension, syncope

What do treatment goals include for AF?

Reduced mortality, symptom relief, increased quality of life, reduce co-morbidities, reduce hospitalization

What is the treatment of tachyarrhythmia?

Rate & rhythm control

Where is the highest risk for thrombus formation in the heart during AF?

Left atrial appendage

What is the CHADS2 score for Congestive heart failure/LV dysfunction?

1

What is the CHADS2 score for Hypertension?

1

What is the CHADS2 score for Age ≥75?

1

What is the CHADS2 score for Diabetes mellitus?

1

What is the CHADS2 score for Stroke/TIA/thromboembolism?

2

What is the CHA2DS2VASc2 score for Congestive heart failure/LV dysfunction?

1

What is the CHA2DS2VASc2 score for Hypertension?

1

What is the CHA2DS2VASc2 score for Age ≥75?

2

What is the CHA2DS2VASc2 score for Diabetes mellitus?

1

What is the CHA2DS2VASc2 score for Stroke/TIA/thromboembolism?

2

What is the CHA2DS2VASc2 score for Vascular disease (previous MI, PAD, aortic plaque)?

1

What is the CHA2DS2VASc2 score for Age 65-74?

1

What is the CHA2DS2VASc2 score for Female sex?

1

What CHA2DS2VASc score does a woman need for No anticoagulant therapy is reasonable?

1

What CHA2DS2VASc score does a man need for No anticoagulant therapy is reasonable?

0

What CHA2DS2VASc score does a woman need for Anticoagulant therapy may be considered?

2

What CHA2DS2VASc score does a man need for Anticoagulant therapy may be considered?

1

What CHA2DS2VASc score does a woman need for oral anticoagulant therapy recommended?

3

What CHA2DS2VASc score does a woman need for oral anticoagulant therapy recommended?

2

What drugs are used for AF?

Warfarin, apixaban, rivaroxaban, edoxaban, dabigatran

What are the two conditions where warfarin is preferred over DOACs for AF?

Mitral stenosis or mechanical heart valve

What is the dosing for dabigatran AF?

150mg PO BID

What is the dosing for dabigatran AF if the CrCl 15-30 mL/min?

75mg PO BID

What is the dosing for rivaroxaban AF?

20mg po daily

What is the dosing for rivaroxaban AF if the CrCl 15-30 mL/min?

15mg PO daily with food

What is the dosing for apixaban AF?

5mg po bid

What are the three criteria used to determine if the Apixaban (Eliquis®) dose should be reduced to $2.5 \, \text{mg BID}$?

Age > 80, weight < 60 kg, and Scr ≥ 1.5 mg/dL

What is the dosing for apixaban if 2 of the 3 is met?

2.5mg PO BID

What is the dosing for edoxaban AF if the CrCl 15-30 mL/min?

60mg po daily

What is the dosing for rivaroxaban AF if the CrCl 15-30 mL/min?

30mg PO daily

What is the contraindication for using Edoxaban (Savaysa®) in AF based on renal function for CrCl?

> 95 mL/min

Which enzyme is primarily responsible for the metabolism of Warfarin?

CYP 2C9

What control is cardioversion then antiarrhythmic drugs to maintain NSR?

Rhythm control

What control is rate-control medications?

Rate control

What do you want to increase in AF?

Ventricular filling time

What is the goal HR for AF?

< 100-110 bpm

What drugs are used for rate control in AF?

BB, Non-DHP CCBs, Digoxin

What type of beta blockers are used for rate control in AF?

Carvedilol, metoprolol succinate, & bisoprolol

What is digoxin in charge of for rate control?

Systolic HF, Hypotension, Sedentary

What drug binds competitively to Na-K-ATPase, Positive inotrope, negative chronotrope?

Digoxin

What is the dosing for digoxin?

125-500 mcg daily

How is digoxin excreted?

Renally

What is done if hymodynamically unstable?

Rapid ventricular response

Identify early signs and symptoms of Digoxin toxicity.

Anorexia, nausea, vomiting, diarrhea, visual disturbances (yellow halos), and headaches.

What are the two strategies for rhythm control?

Direct current cardioversion & pharmacological cardioversion

What is a Electric “shock” attempt to restore NSR?

Direct current cardioversion

What is an emergent cardioversion?

Hemodynamically unstable

Which anti-arrhythmic drugs (AADs) have proven efficacy for pharmacological cardioversion?

Amiodarone, Dofetilide, Ibutilide (IV), Flecainide, and Propafenone.

WHen does a person have a risk of thromboembolism?

AF > 2 days

Which test is better to see atrium?

transesophageal echocardiogram (TEE)

What drug is Class III, activity from all 4 Vaughn-Williams classes, Prolongs QT and refractoriness, Slows HR, AV node conduction, and intracardiac conduction?

Amiodarone

What drug is the most effective AAD?

Amiodarone

What is the mechanism of action of Amiodarone?

Class III agent with activity from all $4$ Vaughn-Williams classes; prolongs QT and refractoriness.

What is the estimated half-life of Amiodarone?

$$\sim 60 \text{ days}$$

What is considered the most serious toxicity associated with Amiodarone?

Pulmonary fibrosis

What is the Black Box Warning for Dronedarone (Multaq)?

Increased risk of death with decompensated HF or permanent AF.

At what QT interval measurement is Sotalol (Betapace AF) contraindicated?

$$> 450 \, \text{msec}$$

Which AAD is associated with the highest risk of Torsades de Pointes ($0.3-4.7\%$)?

Dofetilide (Tikosyn)

What is the 'pill-in-the-pocket' approach in AF management?

The patient only takes an oral medication (like Flecainide or Propafenone) when having an episode of AF.

Which AADs are contraindicated in patients with structural heart disease?

Flecainide and Propafenone

What is the primary indication for AV node ablation?

If anti-arrhythmic medications are ineffective, contraindicated, or not tolerated; results in a permanent pacemaker.