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  #1  
Old 08-25-2013
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EKG Atrial Fibrillation Treatment

Treatment of a fib recap:

-unstable or more than 48 hrs:
Synchronized cardioversion

-stable or less than 48 hrs:
Rhythm and rate control with b-blockers, CCB, digoxin
Anticoagulation (based on CHADS2) with aspirin or warfarin

Something feels funny about a fib management. I never get the questions right so I want to straighten it up in my head from A to Z
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Old 08-25-2013
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So no one on this forum knows how to treat an a fib?!

Awesome.
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Old 08-25-2013
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Quote:
Originally Posted by Renaissance View Post
Treatment of a fib recap:

-unstable or more than 48 hrs:
Synchronized cardioversion

-stable or less than 48 hrs:
Rhythm and rate control with b-blockers, CCB, digoxin
Anticoagulation (based on CHADS2) with aspirin or warfarin

Something feels funny about a fib management. I never get the questions right so I want to straighten it up in my head from A to Z
yep you ve got it right..

But for more chronic than 48 hours, rythm control is not indicated any more, if you decide to shock for some reason you must do an echo to rule out thrombus that is if he is stable...unstable always shock!
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Old 08-26-2013
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what i have learnt from mtb is
acute unstable..shock
acute stable...rate control and anticoagulate
chronic stable... first anticoagulate then shock if need be but even then that will revert back to afib because chronic state is usually due to anatomic abnormality which u cant correct with cardioversion
and as u stated chads score for anticoagulant choice...
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  #5  
Old 09-04-2013
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Ok so I'm trying to understand here something.
I wento to Kaplan notes and check the algorithm they have on Atrial Fib.

Why is it that if more than 48h you do inmediate cardioversion and if less than 48 h you anticoagulate and do elective cardioversion 3 weeks later?

My reasoning will be the oppositesince after 48 h you have chances of getting thrombus formation in the atria.

I'm confussed.

HELP
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Old 09-05-2013
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Quote:
Originally Posted by evavar View Post
Ok so I'm trying to understand here something.
I wento to Kaplan notes and check the algorithm they have on Atrial Fib.

Why is it that if more than 48h you do inmediate cardioversion and if less than 48 h you anticoagulate and do elective cardioversion 3 weeks later?

My reasoning will be the oppositesince after 48 h you have chances of getting thrombus formation in the atria.

I'm confussed.

HELP
I guess arrhythmia is a tough subject everyone avoids lol
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Old 09-05-2013
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I guess Kaplan is wrong.

Thing is when is over 48h give anticoagulation and do elective cardioversion after 3 weeks of anticoagulation.
LOL
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Old 09-05-2013
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Quote:
Originally Posted by evavar View Post
I guess Kaplan is wrong.

Thing is when is over 48h give anticoagulation and do elective cardioversion after 3 weeks of anticoagulation.
LOL
Kaplan is wrong?
Thou shall not cross this line again!
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Old 09-05-2013
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Quote:
Originally Posted by Renaissance View Post
Kaplan is wrong?
Thou shall not cross this line again!

Yes My friend. Kaplan is wrong
The algorithm for management of Atrial Fib has a big mistake.
I corroborate the info with FA for CK, also checked EM book.
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Old 09-10-2013
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And if its > 48 hrs and unstable pt---> cardioversion directly
Am I right?
another thing is..what to do if CHADS score is 0, do we give aspirin or not?
score 1- aspirin or warfarin depending upon patient preference
score 2 or more- give warfarin for sure
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