documentfa
DESCRIPTION
Exposición del Dr. Julio Vizcarra sobre Fibrilación Auricular- 2009TRANSCRIPT
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JULIO D. VIZCARRA ANAYA
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DEFINICION
Taquiarritmia Supraventricular
ECG: No P Irregular frecuencia ventricular rápida
Si R-R regular y lento ??? Si R-R regular y rápido ???
* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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CLASIFICACION
* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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FACTORES PREDISPONENTES
* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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CLINICA
Palpitaciones.Dolor toráxico.Disnea.Fatiga.Síncope.Poliuria???.
* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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EVALUACION CLINICA
* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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BNP o N- terminal pro BNP
ANP
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MANEJO
CONTROL DE LA FRECUENCIA.
PREVENCION DE TROMBOEMBOLISMO.
CORRECCION DEL RITMO.
* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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CONTROL DE FRECUENCIA CARDIACA
CLASE I Beta Blocker o Antagonista Canales de Calcio
No dihidropiridinicos para FA permanente o persistente en ausencia de pre-excitación.
Digoxina (VO) en asociación con HF, disfunción VI.
* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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CLASE IIa Procainamida o Ibutilide en Cardioversión
farmacológica.
Amiodarona si falla lo demás o existe contraindicación.
* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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CLASE III Digoxina no puede ser usado como agente solo
para control de la frecuencia cardiaca.
Si HF o Sd. Pre-excitación, los No dihidropiridinicos no están recomendados.
* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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Enalapril o Irbesartran + Amiodarona **
* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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PREVENCION DEL TROMBOEMBOLISMO
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* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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PREVENCION DEL TROMBOEMBOLISMO CLASE I
Terapia Antitrombótica en todos, excepto “Solo FA” o en contraindicaciones.
Sin prótesis mecánica y riesgo alto de stroke, (CHADS2 >=2) anticoagulación con INR 2 – 3.
Protesis mecanica, anticoagulacion con INR 2.5
01 factor de riesgo moderado mas, anticoagulación.
Aspirina en Bajo riesgo o contraindicados de Anticoagulación.*Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354*Singer Daniel E. , MD. Antithrombotic Therapy in Atrial Fibrillation. 2008. American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
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CLASE IIa Suspensión de anticoagulación para
procedimientos: 1 semana antes sin substitución, sin válvula protésica. 1 semana antes con substitución en alto riesgo.
Si existe riesgo de sangrado???
* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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CORRECCION DEL RITMO
CLASE I Respuesta Ventricular rápida sin respuesta a
fármacos o Angina, isquemia miocárdica, falla cardiaca o hipotensión, Cardioversión eléctrica.
Si no hay respuesta, adicionar fármaco antiarrítmico y cardiovertir nuevamente.
100 J Monofásico – 200 J Bifásico.
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CLASE I Si mayor de 48 hrs. anticoagular antes. Si requiere Cardioversión de inmediato,
anticoagulación en bolo.
CLASE IIa ETE como alternativa a anticoagulación. Si hay trombos anticoagulación oral.
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CARDIOVERSION ELECTRICA Indicaciones Sedación. Modo Bifásico, sincronizado.
* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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CORRECCION DEL RITMO
CLASE I Flecainide, Dofetilide, Propafenona o Ibutilide.
CLASE IIa Amiodarona.
CLASE III Digoxina y Sotalol proscritos.
* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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* Valentin Fuster, MD, PhD. Et Al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation. Circulation. 2006;114:e257-e354
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GRACIAS