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1.02) CARDIOVASCULAR SYSTEM > 11.1 MTB Step 3 - Arrhythmias (A-Fib & A-Flutter) > Flashcards

11.1 MTB Step 3 - Arrhythmias (A-Fib & A-Flutter) Flashcards

1
Q

ATRIAL FIBRILLATION (A-FIB)

  1. What are (2) Physical Signs/Symptoms in a patient with A-Fib?
  2. What are (3) Disorders found in the History of a patient with A-Fib?
A

Presentations:

  1. Palpitations
  2. Irregular Pulse

Associated Disorders:

  1. Hypertension (HTN)
  2. Ischemia
  3. Cardiomyopathy
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2
Q

ATRIAL FIBRILLATION (A-FIB)

  1. What is the Best INITIAL Diagnostic Test for A-Fib?
  2. If the Initial Test is inconclusive for A-Fib, what is the Next Best Test for Inpatients/Outpatients?
A
  1. Electrocardiogram (ECG)
  2. Next Best Test (if ECG is inconclusive):
    • ​​Inpatient = Telemetry monitoring
    • Outpatient = Holter monitoring (24-hrs+)
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3
Q

ATRIAL FIBRILLATION (A-FIB)

What are the (3) Simplified Criteria for recognizing A-Fib on ECG?

A
  1. Multifocal F-waves replace P-waves at an Atrial Rate of 350 - 650 bpm.
  2. Irregular Ventricular response
    • ​​R-R Cycle constantly varying.
    • If the Ventricular Rate is Rapid, Irregularity is More Difficult to determine.
  3. Normal QRS

*SOURCE: 12-Lead ECG Interpretation

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4
Q

ATRIAL FIBRILLATION (A-FIB)

Once A-Fib is found on initial diagnostic testing, what are (4) other Tests you should order for CCS Cases?

A
  1. Echocardiography: Looking for clots, valve function, and Left Atrial size.
  2. Thyroid Function Testing: T4 and TSH levels.
  3. Electrolytes: Potassium, Magnesium, and Calcium levels.
  4. Troponin or CK-MB: These may be appropriate to test in some acute-onset cases.
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5
Q

ATRIAL FIBRILLATION (A-FIB)

MANAGEMENT

What are (3) Drug Therapies used in STABLE patients with A-Fib, and what is their Mechanism of Action (MOA)?

A

Drug Therapies:

  1. Beta Blockers (Metoprolol, Carvedilol)
  2. Calcium Channel Blockers (Diltiazem)
  3. Digoxin

MOA:Stable patients should have their Ventricular Heart Rate slowed with one of the following if it is > 100 - 110 bpm. The 3 Drugs above do that.

Give these IV if patients presents in ED

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6
Q

ATRIAL FIBRILLATION (A-FIB)

MANAGEMENT

What is the Treatment for UNSTABLE patients with A-Fib?

A

Immediate SYNCHRONIZED Electrical Cardioversion

  • Done with the first screen, without waiting for TEE or Anticoagulation with heparin or warfarin
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7
Q

ATRIAL FIBRILLATION (A-FIB)

MANAGEMENT

INSTABILITY is defined as having one of which (4) Disorders/Criteria?

A
  1. Systolic BP < 90mmHg
  2. Congestive Heart Failure (CHF)
  3. Confusion (related to hemodynamic instability)
  4. Chest Pain
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8
Q

ATRIAL FIBRILLATION (A-FIB)

MANAGEMENT

Once the Rate has been controlled in a patient with A-Fib, what is the Next BEST Step in ALL patients with an Atrial Arrhythmia persisting beyond 2 days?

A

Anticoagulation

NOTE: If the question does NOT state the duration of the atrial arrhythmia, treat it as if it were persisting beyond 2 days; Anticoagulate

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9
Q

ATRIAL FIBRILLATION (A-FIB)

MANAGEMENT

What are (4) PO Anticoagulants used to treat persistent A-Fib that have similar or better efficacy compared to Warfarin, but without the need to monitor the INR?

A
  1. D abigatran
  2. E doxaban
  3. A pixaban
  4. R ivoaroxaban

“DEAR A-Fib”

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10
Q

ATRIAL FIBRILLATION (A-FIB)

ANTICOAGULATION

The Long-Term use of the Combination of which (2) Types of Medications is equal or better than Cardioversion with electricity or medications?

A

Rate Control Medications

(e.g., Metoprolol, Diltiazem, Digoxin)

+

Anticoagulation

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11
Q

ATRIAL FIBRILLATION (A-FIB)

ANTICOAGULATION

What is a CHADS2 Score and what does the acronym stand for?

A

CHADS2 is a Scoring System to indicate the Need for Anticoagulation

  • C HF
  • H ypertension
  • A ge > 75
  • D iabetes
  • S troke/TIA
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12
Q

ATRIAL FIBRILLATION (A-FIB)

ANTICOAGULATION

How is a CHADS2 Scored?

A
  • A CHADS2 Score of 0 or 1 = Aspirin
  • A CHADS2 Score of 2 or more = control the Rate and Anticoagulate

Anticoagulation:Warfarinor aNOAC (Apixaban, Dabigatran, Edoxaban, or Rivaroxaban)

  • Unlike Warfarin, NOACs do NOT need several days to reach therapeutic levels.
  • Even when Warfarin is used for A-Fib, there is NO need to bolus (“bridge”) with heparin.
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13
Q

ATRIAL FIBRILLATION (A-FIB)

ANTICOAGULATION

What is a CHADS-VASc Score and what does the acronym stand for?

A

CHADS-VASc adds 3 criteria to the CHADS2 Scoring System to indicate the Need for Anticoagulation

  • C HF
  • H ypertension
  • A ge > 75
  • D iabetes
  • S troke/TIA
  • V ascular Disease
  • A ge 65 - 74
  • S ex (FEMALE)
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14
Q

ATRIAL FIBRILLATION (A-FIB)

ANTICOAGULATION

How is a CHADS-VASc Scored?

A

A CHADS-VASc is scored the same as a CHADS2:

  • A CHADS-VASc Score of 0 or 1 = Aspirin
  • A CHADS-VASc Score of 2 or more = control the Rate and Anticoagulate

Anticoagulation:Warfarinor aNOAC (Apixaban, Dabigatran, Edoxaban, or Rivaroxaban)

  • Unlike Warfarin, NOACs do NOT need several days to reach therapeutic levels.
  • Even when Warfarin is used for A-Fib, there is NO need to bolus (“bridge”) with heparin.
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15
Q

ATRIAL FIBRILLATION (A-FIB)

ANTICOAGULATION

  1. What is the Mechanism of Action (MOA) for the (3) New Oral AntiCoagulants (NOACs) Apixaban, Rivaroxaban, and Edoxaban?
  2. What is the Mechanism of Action (MOA) of the New Oral AntiCoagulant (NOAC) Dabigatran?
A
  1. Apixaban, Rivaroxaban, Edoxaban = Inhibit Factor Xa
  2. Dabigatran = Inhibits Thrombin
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16
Q

ATRIAL FIBRILLATION (A-FIB)

ANTICOAGULATION

  1. How do you Manage Severe Bleeding that occurs with Warfarin?
  2. How do you Manage Bleeding that occurs with Dabigatran?
A

Severe Bleeding caused by Warfarin is Reversed with:

Fresh Frozen Plasma (FFP)

Bleeding caused by Dabigatran is Reversed with:

Idarucizumab

Bleeding caused by Xa Inhibitors (NOACs) is Reversed with:

Andexanet

17
Q

ATRIAL FIBRILLATION (A-FIB)

ANTICOAGULATION

What are the (4) Main Bullet Points to know about NOACs for Step 3?

A
  1. NOACs Prevent more Strokes than warfarin.
  2. NOACs cause Less Intracranial Bleeding than warfarin.
  3. NOACs decrease Mortality more than warfarin in A-Fib
  4. NOACs treat DVT and PE.
18
Q

ATRIAL FLUTTER (A-FLUTTER)

Concerning Rate & Rhythm in the evaluation of Arrhythmias, what is the ONLY difference between A-Fib and A-Flutter?

A

Atrial Flutter = REGULAR Rhythm

19
Q

ATRIAL FLUTTER (A-FLUTTER)

MANAGEMENT

How is A-Flutter Managed?

A

A-Flutter is managed the same way s A-Fib:

  • Stable A-Flutter
    • Beta Blockers (Metoprolol, Carvedilol)
    • Calcium Channel Blockers (Diltiazem)
    • Digoxin
  • Unstable A-Flutter
    • Immediate SYNCHRONIZED Electrical Cardioversion
20
Q

A-FIB & A-FLUTTER

A patient with one of which (4) Disorders should receive Beta-Blockers for Rate Control with A-Fib or A-Fluter?

A
  1. Ischemic Heart Disease
  2. Migraines
  3. Graves Disease
  4. Pheochromocytoma
21
Q

A-FIB & A-FLUTTER

A patient with one of which (2) Disorders should receive Calcium Channel-Blockers for Rate Control with A-Fib or A-Fluter?

A
  1. Asthma
  2. Migraine
22
Q

A-FIB & A-FLUTTER

A patient with which Disorder should receive Digoxin for Rate Control with A-Fib or A-Fluter?

A

Borderline Hypotension

1.02) CARDIOVASCULAR SYSTEM (22 decks)

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