2. Atrial Fibrillation

Question 1

AF

RATE CONTROL
4

Answer 1

B. Blockers not SOTALOL

VERAPAMIL
DILITAZEM
(not in HF or combined with BB)

DIGOXIN
(Ok in HF; not in paroxysmal AF)

Question 2

What has to be done before & after

Electro cardioversion

Answer 2

3 weeks before and 4 weeks after pts have to be fully anticoagulated

Question 3

AF
Long term maintenance

Rate

Rhythm

Answer 3

RATE CONTROL

1. B.BLOCKER (atenolol, bisoprolol,Metoprolol) NOT SOTALOL

If no improvement:

2. ADD rate limiting CCB (verapamil, dilitiazem)
   (Avoid in HF)

If no improvement or CI

3. DIGOXIN (only in sedentary pts with non paroxysmal AF)

STILL NO IMPROVEMENT ?

OR AFTER CARDIOVERSION
RHYTHM CONTROL:

4.B.blocker SOTALOL

OR

ANTI-ARRHYTHMICS

• amiodarone
• flecainide
• propafenone
• dronedarine

Question 4

All AF or Atrial flutter has to be assessed for which risk?

Answer 4

Thrombotic stroke risk

CHA2-DS2-VASc

Question 5

Thrombotic stroke risk
CHA2-DS2-VASc

What is considered in this risk calculator?

Answer 5

C chronic heart failure or LVSD
H Hypertension
A2 Age -75+

D Diabetes 
S2 Stroke/history DVT
V vascular disease 
A age 65-75 yes 
Sc sex- F 

Anticoagulant should be given if 1 point for female or 2 for men

Question 6

AF 
types (3) and duration

Answer 6

Paroxysmal AF: 48hrs or less

Persistent AF: 7 days and more (until treated)

Permanent AF: all the time (1yr +)

Question 7

What is 
Atrial fibrillation (AF)

Answer 7

Abnormal disorganised electrical signals causing atria to shake causing a rapid irregular heart beats

The most common arrhythmia

Question 8

What can AF cause

(Other conditions to the heart) 3

Answer 8

Stroke
Hypertension
Heart failure HF

Question 9

AF

SYMPTOMATIC tx

Answer 9

“Pill in pocket”

Self tx

Flecainide or propafenone

Question 10

AF

Acute
Non-life threatening

> 48 hrs

Answer 10

Rate control

-IV beta blocker (NOT SOTALOL)

OR

-IV Veramapil/Dilitiazem

Question 11

Non cardiac causes of AF (4)

Answer 11

Diabetes
Thyrotoxicosis (thyroid excess)
Hypokalaemia
Hyponatremia (low NA)

Question 12

When stroke risk in higher than the bleeding risk

Anticoagulant has to be given

New on set AF
Diagnosed AF

Pts with non valvular AF

Answer 12

New on set:

Parental heparin

Diagnosed:

Oral warfarin

Pts with non valvular

NOAC Oral
: apixaban,rivaroxaban, endoxaban, dabigatran

Question 13

AF

Acute treatment

Life threatening

Answer 13

Stat parental anticoagulant
Heparin

Stat electrical cardioversion

Question 14

AF

PAROXYSMAL AF tx

Answer 14

B blocker

OR

ANTI ARRHYTHMICS

Question 15

AF

Symptoms

Answer 15

Palpitations
Dizziness
Shortness of breath
Tiredness

Pts describe it as a “floppy fish” in chest

Question 16

Bleed risk

HAAS BLED

What is calculated? (Factors)

Answer 16

H Hypertension
A abnormal liver function
A abnormal renal function
S Stroke

B bleeding
L labile INRs (<60%)
E elderly 65+
D Drugs (anti platelets or NSAIDs)

Only give anticoagulant if stroke is bigger than the risk of bleeding

Question 17

Tx for AF is the same as the treatment for..?

But catheter ablation is better

Answer 17

Atrial fluttter

Question 18

AF

RHYTHM control

(5)

Answer 18

B.BLOCKERS including SOTALOL

Flecainide

Amiodrone

Propafenone

Dronedarone

Question 19

AF
Acute

Managment non-life threatening

<48 hrs

Answer 19

Rate or rhythm (rhythm preferred )

Electrical cardioversion

OR

pts with HF

IVE amidorone

OR

Pts with first onset of AF

Flecainide