INCOMPLETE Arrhythmia Knowledge Checks and Post Work

Which of the following is the preferred anticoagulant in a patient with atrial fibrillation and severe mitral stenosis?

Warfarin

A 68-year-old female presents to her cardiologist's office with new onset atrial fibrillation. She has no vascular abnormalities. Her medical history is significant for DM, HTN, and stage 3 chronic kidney disease (SCr = 1.5 mg/dL); Ht: 5' 0" Wt = 55 kg. Medications include: lisinopril 20 mg po daily, furosemide 40 mg po daily, insulin glargine 15 units subcutaneously daily, and insulin aspart 5 units subcutaneously TID with meals.

Determine the score for this patient.

4

A 68-year-old female presents to her cardiologist's office with new onset atrial fibrillation. She has no vascular abnormalities. Her medical history is significant for DM, HTN, and stage 3 chronic kidney disease (SCr = 1.5 mg/dL); Ht: 5' 0" Wt = 55 kg. Medications include: lisinopril 20 mg po daily, furosemide 40 mg po daily, insulin glargine 15 units subcutaneously daily, and insulin aspart 5 units subcutaneously TID with meals.

Which of the following is dosed correctly for the above patient for the prevention of stroke in atrial fibrillation?

Apixaban 2.5 mg po BID

Which of the following are important counseling points or clinical considerations for patients taking rivaroxaban?

A. Take with food for consistent absorption.

B. There is a higher risk of stroke in patients with CrCl > 95 mL/min

C. The dose should be reduced to 15 mg po daily in patients with an estimated CrCl < 50 mL/min

D. Andexanet alfa is indicated to reverse life-threatening bleeding associated with rivaroxaban.

A, C, and D

Which of the following is a contraindication to the initiation of dofetilide?

QTc > 440 msec

Which of the following agents may be utilized for cardioversion, but not maintenance of sinus rhythm?

Ibutilide

Metoprolol

Rate control agent

Digoxin

Rate control agent

Diltiazem

Rate control agent

Verapamil

Rate control agent

Dofetilide

Rhythm control agent

Propafenone

Rhythm control agent

Ibutilide

Rhythm control agent

Which of the following may be utilized for rate control and also may be used as an effective antiarrhythmic to maintain sinus rhythm?

Amiodarone

Which of the following agents require hospitalization and ECG monitoring upon initiation?

A. Amiodarone

B. Dofetilide

C. Ibutilide

D. Sotalol

E. Dronedarone

B, C, and D

Which of the following would be pharmacotherapeutic options for conversion to normal sinus rhythm in a symptomatic patient with atrial fibrillation (no PMH) who requires outpatient treatment? Select all that apply.

A. Ibutilide

B. Amiodarone

C. Propafenone

D. Dronedarone

E. Sotalol

B and C

3 multiple choice options

Which of the following antiarrhythmics should be avoided in patients with structural heart disease (e.g. myocardial infarction, HFrEF)? Assume no recent HF decompensation. Select all that apply.

A. Propafenone

B. Sotalol

C. Flecainide

D. Amiodarone

A and C

Which of the following is an appropriate option for maintenance of sinus rhythm, but not appropriate for acute cardioversion?

Sotalol

2 multiple choice options

A 68-year-old man is newly diagnosed with nonvalvular atrial fibrillation (AFib). He has a history of hypertension, peripheral artery disease, and dyslipidemia. His current blood pressure is 138/84 mmHg, HR = 120 bpm. He is experiencing some fatigue and palpitations, but does not require hospitalization. He has no history of heart failure or prior stroke.

Current medications include: aspirin 81 mg po daily, atorvastatin 40 mg po daily, lisinopril 10 mg po daily

SCr = 1.1 mg/dL. Hepatic function is normal. CrCl = 75 mL/min

What is this patient's CHA2DS2-VASc score?

3

3 multiple choice options

A 68-year-old man is newly diagnosed with nonvalvular atrial fibrillation (AFib). He has a history of hypertension, peripheral artery disease, and dyslipidemia. His current blood pressure is 138/84 mmHg, HR = 120 bpm. He is experiencing some fatigue and palpitations, but does not require hospitalization. He has no history of heart failure or prior stroke.

Current medications include: aspirin 81 mg po daily, atorvastatin 40 mg po daily, lisinopril 10 mg po daily

SCr = 1.1 mg/dL. Hepatic function is normal. CrCl = 75 mL/min

Which of the following is the most appropriate option for anticoagulation and stroke prevention?

Dabigatran 150 mg po BID

3 multiple choice options

A 68-year-old man is newly diagnosed with nonvalvular atrial fibrillation (AFib). He has a history of hypertension, peripheral artery disease, and dyslipidemia. His current blood pressure is 138/84 mmHg, HR = 120 bpm. He is experiencing some fatigue and palpitations, but does not require hospitalization. He has no history of heart failure or prior stroke.

Current medications include: aspirin 81 mg po daily, atorvastatin 40 mg po daily, lisinopril 10 mg po daily

SCr = 1.1 mg/dL. Hepatic function is normal. CrCl = 75 mL/min

My recommended heart rate goal for this patient is...

< 110 bpm

2 multiple choice options

A 68-year-old man is newly diagnosed with nonvalvular atrial fibrillation (AFib). He has a history of hypertension, peripheral artery disease, and dyslipidemia. His current blood pressure is 138/84 mmHg, HR = 120 bpm. He is experiencing some fatigue and palpitations, but does not require hospitalization. He has no history of heart failure or prior stroke.

Current medications include: aspirin 81 mg po daily, atorvastatin 40 mg po daily, lisinopril 10 mg po daily

SCr = 1.1 mg/dL. Hepatic function is normal. CrCl = 75 mL/min

Which of the following would be appropriate to initiate for rate control in this patient? Select all that apply.

A. Metoprolol succinate

B. Diltiazem

C. Verapamil

D. Atenolol

All of the above

3 multiple choice options

Which of the following requires ECG monitoring of the QTc interval during initiation of therapy? Select all that apply.

A. Flecainide

B. Dofetilide

C. Ibutilide

D. Digoxin

A, B, and C

3 multiple choice options