Term
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Definition
| A-Fib, the most common arrhythmia, is characterized by rapid, irregular contractions in the atria that cause irregular and often rapid contractions of the ventricles. (Bonus accounts for 15-20% of ischemic strokes) |
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Term
| What are the three treatment strategies for aFib? What are the 3 treatment goals for aFib? |
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Definition
| Strategies - Rate control, Rhythm control and anticoagulation therapy. Goals - Regain a normal heart rate, Regain a normal sinus rhythm, Prevent Thromboembolism. |
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Term
Why is a patient with a-Fib at a higher risk of stroke than patients without a-Fib?
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Definition
| Because blood pools in the left atrial appendage due to irregular and poorly coordinated atrial contractions. Pooling blood leads to formation of a thrombus which can embolize. |
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Term
| Name at least 5 Risk Factors for aFib |
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Definition
| Increasing Age, diabetes, LV hypertrophy, hypertension, MI, CHF, Valvular Heart Disease, obesity (inflammation due to previous cardiac surgery, pericarditis, myocarditis, elevated C-reactive protein) |
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Term
| What are the different classifications of aFib based on duration of symptoms? |
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Definition
| Primary or Secondary, Valvular or Non-valvular, First detected or Recurrent: Paroxysmal (self terminating – less than 7 days), Persistent (not self terminating lasting longer than 7 days up to a year), Permanent (AF lasting longer than a year where DCC is not indicated OR one or more attempts have failed to restore sinus rhythm), Lone (patients younger than 60 with no evidence of Cardiopulmonary disease including hypertension), Long-standing Persistent (New ESC classification – AF lasting more than a year) |
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Term
| Trace the electrical impulse through the heart’s electrical system. At which point do the atrium and ventricles contract? What happens to this process when aFib is present? |
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Definition
| SA Node through the atria to the AV Node (Atria contract). AV Node through the left and right Bundle Branches, the Perkinje Fibers and into the ventricular myocardium (ventricles contract). Reentry is when a cardiac cell is re-excited out of sequence by an abnormal pathway. An abnormal electrical impulse coming from a location outside of the SA Node – usually the pulmonary veins. |
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Term
| Name at least 5 common symptoms of aFib and 2 emergency situations. |
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Definition
| Common Symptoms - Palpitations, dyspnea, dizziness, chest pain, weakness, fatigue, anxiety, frequent urination Emergent Situations – Stroke, Acute Heart Failure, Left Ventricular Hypertrophy and hemodynamic changes |
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Term
| Describe the process used to diagnose a patient with symptoms consistent with a-Fib. |
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Definition
| Patient history and physical, blood tests (thyroid, renal and hepatic function, electrolytes such as sodium, potassium and calcium), 12 lead ECG (perhaps a Holter Monitor), TTE (transthoracic echocardiogram) |
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Term
| What is CHADS²? What does it stand for? What does it measure? How are points assigned? |
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Definition
| A classification system to estimate the ANNUAL risk of stroke in patients with a-Fib and recommend appropriate anticoagulation choices based upon risk. CHF, Hypertension, Age, Diabetes, Stroke or TIA. 1 point for each except Stroke or TIA which gets 2 points. Each CHADS point represents about a 2% annual risk of stroke. |
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Term
Why is it important that patients with recurrent, paroxysmal a-Fib and CHADS² scores greater than 1, receive anticoagulation therapy?
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Definition
| Because between 10% - 40% of patients are asymptomatic. Patients can develop a thrombus if in a-Fib for 48 hours. This means that recurrent paroxysmal a-Fib patients could form a clot in the LAA without even knowing they were in a-Fib before their a-Fib self terminates. |
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