Afib noon conference 6.28.2018

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Virginia Mason Internal Medicine Residency

Health & Medicine

Noon Conference
R. Benzar
NOON CONFERENCE
6.28.2018

DEFINITION Disorganized atrial activity.
POPULATION >40y/o, 1/ 4 lifetime risk AFIB. Age.
INCITING FACTORS Hyperthyroidism, cardiac sgy/recent sgy, PE,
heart DZ (HTN/structural), OSA, infection,
COPD/meds, ischemia, acute pericarditis.
SYMPTOMS Palpitations, lightheadedness, dizziness,
dyspnea, exercise intolerance, CP, syncope, HF
2/2 tachycardia.
WORK-UP TSH/fT4, TTE, infx, CXR (COPD/PNA), trop (+/-
), EKG (obvs).
DIAGNOSIS/CLASSIFICATION EKG/tele. New-onset, paroxysmal, persistent
(>7d), long-standing (>1y).
TREATMENT Prevent stroke / control HR / SX relief.

4 options for rate-controlling
medications?

Page: So, his pressure is 105/63; hr
178. Just got metop tart 10 mg iv x 1.
Please advise.
HOW DO YOU RESPOND?

ACUTE
ANTICOAG
ULATION CHRONIC
ANTICOAG
ULATION

What was his chads2vasc? SHOULD WE
ANTICOAGULATE HIM?
a. 1; YES
b. 1; NO
c. 2; YES
d. 2; NO
e. 3; YES
f. 3; NO

My chads2vasc is only 1.
But…
(mitral stenosis / rheumatic / clots / prosthetic
valves / la apppendage thrombus / hcm)
Should i anticoagulate?

I JUST HAD AN ABLATION FOR MY ATRIAL
FIBRILLATION. DO I NEED TO CONTINUE
MY WARFARIN?
a. YES; 3 MONTHS
b. YES; 6 MONTHS
c. YES; 12 MONTHS
d. YES; LIFETIME
e. NO

Mix & match:
1. Dabigatran
2. rivaroxaban
3. Apixaban
4. warfarin
a. Always great. But kinda
messy to check INRs.
b. Noninferior to warfarin
re: stroke prev; less
ICH/fatal bleeding; BUT
more GI bleeds.
c. Better than warfarin
re: stroke prev; less
ICH, BUT more GI bleeds
d. Better than warfarin.
re: stroke prev; less
bleeding overall,
similar rates GI
bleeds.

Mix & match studies:
1. Dabigatran
2. rivaroxaban
3. Apixaban VS. WARFARIN
4. APIXABAN VS. ASA
a. ROCKET-AF
b. RE-LY
c. ARISTOTLE
d. AVERROES

apixaban/aristotle (2011):
PRETTY COOL DUDE.

Other trendy things you should know about that we’re not
discussing today:
Cardioversion (stable/unstable)
Ablation
Complications of afib/anticoagulation
Zebras; also, harps

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