Atrial Fibrillation Quiz Answers
Sorry, I’m still finishing this page up.1. Paroxysmal a. fib is defined as episodes lasting less then: *
24 hours
48 hours
Answer: 1 Week
1 Month
Discussion:
2. Which method of a. fib managment has been shown to have better overall outcomes including mortality? *
Answer: Rate Control
Rhythm Control
Equal Outcomes
Discussion:
3. A 59 y/o male PMH significant for h/o CVA presents with new onset atrial fibrillation. Which of the following is true? *
Pt's CHADS score is 1, so ASA alone is indicated.
Pt's CHADS score is 2, so either ASA or warfarin is indicated.
Answer: Pt's CHADS score is 2, warfarin is indicated.
Pt's CHADS score is 3, warfarin is indicated.
Discussion:
4. Which is Not an indication for urgent cardioversion? *
Evidence of acute ischemia
Answer: Ventricular rate >150
Severe manifestation of heart failure
Hemodynamic instability
Discussion:
5. What percentage of patients who undergo cardioversion are still in stable NSR 1 year after the cardioversion without the use of continued antiarrhythmics. *
Answer: 20%
40%
60%
80%
100%
Discussion:
6. 78 y/o male presents with new onset atrial fibrillation. HR 125 BP: 115/78. You decide to start diltiazem for rate control. Please provide your orders for the diltiazem.
Diltiazem IV push 10mg -20mg x 1 then Diltiazem 10-15mg/hr and titrate to goal heart rate of <80. May repeat with another dose in 15 min if initial dose does not provide rate control.
EBM Answer: 0.25mg/kg IV push x 1. If no response, 0.35mg/kg IV push in 15 minutes. Start drip 5-15mg/hr following bolus.
7. An 86 y/o male admitted for atrial fibrillation 2 days prior. He is now rate controlled with diltiazem at 10mg/hr. Please provide your orders for converting this patient to oral diltiazem. Please show how he came up with this answer.
Short acting diltiazem 90mg po q6 hr, d/c IV drip 1 hour after first dose.
Math: Oral Dilt from IV: [rate (mg/hour) x 3 +3] x 10 = 24 hour dose. In this case, (10x 3 + 3) x 10= 330. Short acting is q 6 hour, so 330/4=82mg (round to closest tablet is 90). Use short acting so that you are not stuck with a 24 hour acting med if it does not work. Adjust as needed. After 24 hours, if doing well, can change to 24 hour acting. Converting to a 24 hour acting dilt is a straight 1:1 math (calculate total dilt pt is receiving in 24 hours, then give same 24 hour acting dose. In this case, 90 x 4 =360mg. Can give 360mg tablet of Diltiazem ER.)
Very important: Stop drip 1 hour after first po dose. Classic mistake is to give the d/c order for the drip along with the order for the po. Problem is that the nurse may stop the drip at the time of the order, but the po med may not come up from the pharmacy for a couple of hours!