Atrial Fibrillation Management Quiz
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Questions and Answers

What is the recommended treatment for a patient with acute limb ischemia due to atrial fibrillation?

  • Flecainide
  • Warfarin
  • Embolectomy (correct)
  • Aspirin

In the CHADS2 scoring system, how many points are assigned for a history of stroke or TIA?

  • 1 point
  • 2 points (correct)
  • 3 points
  • 0 points

When should aspirin be administered according to the CHADS2 score?

  • Only when the patient is asymptomatic
  • If the score is 0 or 1 (correct)
  • If the score is 2 or more
  • For all AF patients

Which medication is typically not used as a first-line treatment for rhythm control in atrial fibrillation?

<p>Warfarin (C)</p> Signup and view all the answers

For a patient with atrial fibrillation and hemodynamic instability, which intervention is indicated?

<p>Electrical cardioversion (A)</p> Signup and view all the answers

Which of the following conditions is NOT a component of the CHADS2 score?

<p>Chronic lung disease (C)</p> Signup and view all the answers

What is the primary reason for prescribing warfarin over aspirin in atrial fibrillation?

<p>Warfarin prevents thromboembolic events more effectively for high-risk patients (C)</p> Signup and view all the answers

In patients with atrial fibrillation, what is the standard procedure before considering rhythm control?

<p>Initiate rate control (C)</p> Signup and view all the answers

What is the most common cause of pericarditis in a patient with rheumatoid arthritis?

<p>Viral infection (C)</p> Signup and view all the answers

Which clinical feature is characteristic of uremic pericarditis?

<p>High levels of creatinine and BUN (C)</p> Signup and view all the answers

What is the recommended initial treatment for pericarditis?

<p>NSAIDs and colchicine (A)</p> Signup and view all the answers

Which type of pericarditis occurs as a reaction to myocardial infarction?

<p>Dressler syndrome (A)</p> Signup and view all the answers

What is the next best step in diagnosing pericarditis after an ECG?

<p>Echocardiography (D)</p> Signup and view all the answers

What condition may be confused with chronic constrictive pericarditis?

<p>Tamponade (C)</p> Signup and view all the answers

Which of the following statements about fibrinous pericarditis is true?

<p>It can occur shortly after a myocardial infarction. (D)</p> Signup and view all the answers

What is a classic infectious cause of chronic constrictive pericarditis?

<p>Tuberculosis (D)</p> Signup and view all the answers

What is the heart rate threshold that characterizes rapid ventricular response in atrial flutter?

<p>Above 150 bpm (D)</p> Signup and view all the answers

Which characteristic appearance do atrial flutter waves display on an ECG?

<p>Classic sawtooth (D)</p> Signup and view all the answers

What distinguishes ventricular tachycardia (VT) from supraventricular tachycardia (SVT) on an ECG?

<p>VT has wide complexes (B)</p> Signup and view all the answers

What is the first step in treating supraventricular tachycardia (SVT) in a stable patient?

<p>Carotid massage (A)</p> Signup and view all the answers

When should direct current cardioversion be considered for a patient with ventricular tachycardia?

<p>If the patient is in coma or has low blood pressure (C)</p> Signup and view all the answers

What is the characteristic QRS duration in ventricular tachycardia?

<p>More than 120 ms (C)</p> Signup and view all the answers

Which of the following is not a typical treatment for premature ventricular complexes (PVCs)?

<p>Amiodarone (D)</p> Signup and view all the answers

Which of the following statements is true regarding the complexes seen in supraventricular tachycardia (SVT)?

<p>They resemble needle shapes (D)</p> Signup and view all the answers

What condition is characterized by pulmonary arteriovenous fistula leading to high-output failure?

<p>Hereditary hemorrhagic telangiectasia (D)</p> Signup and view all the answers

What is the first step in managing a patient suspected of having paroxysmal atrial fibrillation after presenting with a TIA?

<p>Holter monitor (C)</p> Signup and view all the answers

What characteristic pattern is observed in the ECG of a patient with atrial fibrillation?

<p>Irregularly irregular rhythm with absent P-waves (C)</p> Signup and view all the answers

In patients over 75 years old with atrial fibrillation, which potential complication should be primarily considered?

<p>Stroke or TIA (B)</p> Signup and view all the answers

If a patient with atrial fibrillation presents with severe abdominal pain, what diagnosis should be suspected?

<p>Acute mesenteric ischemia (A)</p> Signup and view all the answers

What is the next best step after diagnosing atrial fibrillation with an ECG?

<p>Perform echocardiography (C)</p> Signup and view all the answers

In which condition can intraosseous arteriovenous fistulae occur?

<p>Paget's disease (A)</p> Signup and view all the answers

Which feature is typical of an ECG showing atrial fibrillation?

<p>Random and irregular QRS complexes (D)</p> Signup and view all the answers

What does ST-elevation in leads II, III, and aVF primarily indicate?

<p>Inferior MI possibly involving the right coronary artery (B)</p> Signup and view all the answers

Which artery supplies the apex of the heart?

<p>Left anterior descending artery (A)</p> Signup and view all the answers

What is indicated by ST-elevations in leads V1-V3?

<p>Anterior MI (D)</p> Signup and view all the answers

In a patient with inferior MI and left-dominant circulation, which sequence is expected for vascular supply?

<p>Left main coronary à left circumflex à PDA (D)</p> Signup and view all the answers

Which condition is characterized by a new-onset systolic murmur following an MI?

<p>Mitral regurgitation (A)</p> Signup and view all the answers

What arrhythmia is the most common cause of death following an MI?

<p>Ventricular fibrillation (A)</p> Signup and view all the answers

What do Q waves on an ECG typically indicate?

<p>Old myocardial infarction history (B)</p> Signup and view all the answers

Which statement regarding arrhythmias post-MI is accurate?

<p>Fibrosis of myocardium increases risk of future arrhythmias (A)</p> Signup and view all the answers

What is the first treatment given for a myocardial infarction (MI)?

<p>Aspirin (D)</p> Signup and view all the answers

Which of the following statements is true regarding myocardial infarction and its complications?

<p>MI can cause coagulative necrosis of the myocardium. (C)</p> Signup and view all the answers

What change in hemodynamics is expected during cardiogenic shock due to myocardial infarction?

<p>Decreased cardiac output and increased PCWP (B)</p> Signup and view all the answers

Which medication is typically administered after aspirin in patients with acute coronary syndrome?

<p>Clopidogrel (A)</p> Signup and view all the answers

What is a contraindication for the use of nitrates in MI management?

<p>Right-sided MI (B)</p> Signup and view all the answers

What finding is typically observed on the ECG for ST-Elevation Myocardial Infarction (STEMI)?

<p>Diffuse ST-elevations in all leads (B)</p> Signup and view all the answers

How does a patient with pericarditis typically present regarding pain?

<p>Pain that is relieved by sitting upright (C)</p> Signup and view all the answers

Which of the following conditions can lead to serous pericarditis?

<p>Cocaine use (D)</p> Signup and view all the answers

Flashcards

Atrial fibrillation (AF)

An irregular heart rhythm characterized by a lack of coordinated atrial contractions, resulting in rapid and chaotic electrical activity in the atria.

Left Atrial Mural Thrombus

A blood clot that forms in the left atrium due to the stasis and turbulence of blood flow in AFib.

Embolism

A condition where a blood clot from the heart breaks off and travels through the bloodstream, potentially lodging in vital organs.

Cerebral Embolism

A type of embolism that affects the brain, causing symptoms like stroke, TIA, or retinal artery occlusion.

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Mesenteric Embolism

A type of embolism that affects the arteries supplying the intestines, causing severe abdominal pain.

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Pulmonary Arteriovenous Fistula (PAVF)

An abnormal connection between an artery and a vein, causing a decrease in blood pressure.

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Hereditary Hemorrhagic Telangiectasia (HHT)

A genetic disorder that predisposes individuals to develop PAVF, along with other vascular abnormalities.

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Holter Monitor

A 24-hour continuous electrocardiogram (ECG) recording used to monitor heart rhythm over an extended period.

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Acute Limb Ischemia

A condition where blood flow to a limb is severely reduced, often caused by a blood clot. It is characterized by intense pain, absent pulses, and potential tissue damage.

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CHADS2 Score

A scoring system used to assess the risk of stroke in patients with atrial fibrillation. It takes into account factors such as heart failure, hypertension, age, diabetes, and prior stroke or transient ischemic attack.

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Embolectomy

A procedure that removes a blood clot from an artery, restoring blood flow to the affected limb. It's typically performed in cases of acute limb ischemia.

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Warfarin

A medication used to prevent blood clots in patients with atrial fibrillation, particularly those at high risk of stroke. It works by thinning the blood.

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Aspirin

A medication used to prevent blood clots in patients with low risk of stroke in atrial fibrillation. It is considered less potent than warfarin.

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Rate Control

A type of treatment for atrial fibrillation that aims to slow down the heart rate. It is generally the first line of management for AF, before considering rhythm control options.

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Rhythm Control

A type of treatment for atrial fibrillation that aims to restore the normal rhythm of the heart. It is typically considered after rate control fails or for patients with symptoms despite rate control.

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Atrial Flutter

A heart rhythm abnormality where the atria contract rapidly and chaotically, creating a sawtooth-like pattern on an ECG.

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Ventricular Tachycardia (VT)

A rapid heart rhythm that originates in the ventricles, causing wide, irregular QRS complexes on an ECG.

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Premature Ventricular Complex (PVC)

A premature beat originating in the ventricles, appearing as a wide complex on an ECG.

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Supraventricular Tachycardia (SVT)

A rapid heart rhythm originating above the ventricles, characterized by narrow, needle-shaped QRS complexes on an ECG.

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Carotid Massage

A maneuver used to slow down a rapid heart rate by stimulating the vagus nerve.

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Adenosine

A medication used to treat SVT by slowing down the heart rate.

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Cardioversion

A procedure that delivers an electrical shock to the heart to restore a normal rhythm.

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Cardioversion/Countershock

The primary treatment option for VT or SVT when the patient is unconscious or has low blood pressure.

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STEMI

ST-segment elevations in 3 or more contiguous leads is a characteristic ECG finding. This indicates a complete blockage of a coronary artery, leading to a heart attack.

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Inferior MI

This specific type of MI involves the inferior wall of the heart, indicated by ST-segment elevations in leads II, III, and aVF. The right coronary artery is often implicated in this type of MI.

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LAD blockage

The apex (bottom) of the heart is supplied by the LAD. If there are ST-elevations in leads V1-V3, the LAD is likely the culprit.

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Left Circumflex Blockage

The left circumflex artery supplies the lateral wall. ST-elevations in leads V4-V6 suggest a blockage of this artery.

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Reciprocal ST-depressions in V1-V3

Depressions in leads V1-V3 are a clue for a posterior MI. The electrical activity is traveling through the back wall of the heart, making it look like depressions in the anterior leads.

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Mitral Regurgitation after MI

A new-onset systolic murmur (heart sound) a few days after an MI is a common sign of mitral regurgitation. Damage to the heart valve can cause blood to leak backwards.

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Stroke after MI

Weeks after an MI, there may be a stroke-like presentation due to a blood clot from a ventricular septal aneurysm. This clot breaks off and travels to the brain.

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Death due to MI

The most common cause of death after an MI is ventricular fibrillation, a chaotic and fast heartbeat.

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Pericarditis

Inflammation of the pericardium, the sac surrounding the heart.

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Viral pericarditis

A common cause of pericarditis, often associated with flu-like symptoms.

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Pericarditis & autoimmune diseases

Patients with rheumatoid arthritis or SLE are more prone to developing pericarditis.

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Pericarditis after MI

Pericarditis can occur after a heart attack, either immediately or weeks later.

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Uremic pericarditis

A condition where a patient has high creatinine and urea levels, usually requiring dialysis.

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ECG in pericarditis

The first step in diagnosing pericarditis is usually an ECG.

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Echocardiography in pericarditis

Echocardiography can help visualize fluid build-up around the heart (pericardial effusion).

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Treatment of pericarditis

NSAIDS, colchicine, and steroids are commonly used to treat pericarditis.

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Hx of MI (Heart Attack)

A type of heart attack that causes damage to the heart muscle and increases the risk of various heart rhythm problems.

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Unstable Angina

A condition with symptoms like chest pain that occurs when the heart muscle is temporarily deprived of oxygen, but without permanent damage.

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Coronary Catheterization

A procedure where a thin, flexible tube is inserted into an artery in the heart to diagnose and treat coronary artery disease.

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Aspirin for MI/Unstable Angina

A medication used to prevent blood clots from forming in the blood vessels, often given for patients experiencing a heart attack or unstable angina.

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First Treatment for MI

The first line of treatment for a heart attack is to administer aspirin.

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Serous Pericarditis

A type of pericarditis characterized by a clear fluid buildup in the pericardial sac.

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Pericarditis Pain Pattern

Chest pain that worsens when lying down and improves when leaning forward, often associated with pericarditis.

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Study Notes

Pulmonary Arteriovenous Fistula

  • A diagnosis often associated with hereditary hemorrhagic telangiectasia
  • Characterized by red dots on the tongue, mouth, or fingers
  • May also present in Paget's disease (intraosseous AV fistulae)

Atrial Fibrillation (AF)

  • Irregularly irregular rhythm, absent P-waves
  • Important due to potential for thrombus formation in the left atrium
  • Can lead to various embolic events (stroke, TIA, retinal artery occlusion, mesenteric ischemia, limb ischemia)
  • Often paroxysmal (comes and goes)
  • Older patients (especially over 75) are more frequently affected
  • Normal blood pressure is a key clue in the vignette for AF in older patients
  • If an older patient presents with typical AF symptoms, but has normal blood pressure and sinus rhythm on ECG, a Holter monitor is the next best step to assess for paroxysmal AF
  • Echocardiography is next after diagnosis to visualize the LA mural thrombus
  • Patients with abdominal pain in the setting of AF or hyperthyroidism should raise suspicion for acute mesenteric ischemia; mesenteric angiography would be the next step in evaluation
  • Management involves rate control (e.g., metoprolol, verapamil) before potentially considering rhythm control
  • Aspirin or warfarin is used depending on the CHADS2 score (CHF, HTN, Age 75+, Diabetes, Stroke/TIA)

Atrial Flutter

  • Characterized by sawtooth pattern on ECG
  • Low yield for USMLE

Ventricular Tachycardia (VT)

  • Wide-complex QRS complexes (>120 ms) are a hallmark
  • Significantly higher yield for 2CK

Supraventricular Tachycardia (SVT)

  • Narrow-complex QRS complexes
  • Management: carotid massage, adenosine

Premature Ventricular Complexes (PVCs)

  • Wide-complex, premature beats originating from ventricles
  • Not typically treated

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Description

Test your knowledge on the management of atrial fibrillation, including treatment options, the CHADS2 scoring system, and specific medication uses. This quiz covers critical interventions and considerations for patients at risk of complications related to atrial fibrillation.

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