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Discussion Starter · #1 ·
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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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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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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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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Discussion Starter · #6 ·
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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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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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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