4 Stroke - AF

Question 1

Why are we preventing stroke in people with AF?

Answer 1

• more likely to have stroke

- worse outcomes in stroke

Question 2

How do we assess stroke risk in people with AF?

Answer 2

CHADS VASC

Question 3

CHADS VASC score

Answer 3

CHF/LVD (+1)
Hypertension (+1)
Age >75 (+2)
Diabetes (+1)
Stroke/TIA history (+2)
Vascular disease (+1)
Age 65-75 (+1)
Sex - female (+1)

Question 4

HASBLED scre

Answer 4

Hypertension (+1)
Abnromal renal/hepatic (+1 each)
Stroke (+1)
Bleeding (+1)
Labile INR (+1)
Elderly >65 (+1)
Drugs/alcohol (+1 each)

Question 5

Should we use aspirin in AF?

Answer 5

no - it’s ineffective at preventing strokes

Question 6

Consider anti coagulation with CHADSVASc score over

Answer 6

1

Question 7

Disadvantages of warfarin (4)

Answer 7

Narrow therapeutic window
Inconvenient INR testing
Interactions
Administrative burden to NHS

Question 8

Advantages of Warfarin (3)

Answer 8

Cheap
Familliarity
Easily reversible

Question 9

Advantages of Warfarin (3)

Answer 9

Cheap
Familliarity
Easily reversible

Question 10

HASBLED scre

Answer 10

Hypertension SBP 65 (+1)

Drugs/alcohol - antiplatelets/more than 8 alcoholic drinks perweek (+1 each)

Question 11

Advantages of Warfarin (3)

Answer 11

Cheap
Familliarity
Easily reversible

Question 12

How do we use HASBLED and CHADSVASc?

Answer 12

If HASBLED is greater than CHADSVASc the risk of bleed outweighs the benifit of oral anticoagulants

Question 13

When should you not anticoagulate someone with CHADsVASc =1

Answer 13

if it’s 1 for being a woman

Question 14

In ischamic stroke with AF when do we start anticoagulation?

And in TIA?

Answer 14

Use Asp 300mg OD until

14 days for disabling stroke
less if not disabling

For TIA begin immediately once hemorrhage is ruled out

Question 15

AF symptoms

Answer 15

Lighteadedness
Palpitations
Syncope
Fatigue
Chest pain
SOB

Question 16

What comes first - rate or rhythm control?

Answer 16

Rate

Question 17

What comes first - rate or rhythm control?

Answer 17

Rate

Question 18

What are the types of AF?

Answer 18

Permanent
Persistant - persists until cardioaversion
Paroxysmal - spontaneous end in 7 days

Question 19

What is rate control strategy?

Answer 19

Monotherapy:
-B-blocker or RL-CCB
Dual therapy - any two of:
-B-blocker
-Diltiazem
-Digoxin

Question 20

e.g. of RL -CCBs (2)

Answer 20

diltiazem and verapamil

Question 21

Rhythm control strategy:

Answer 21

Cardioversion
Bisoprolol
Amiodarone
Flecainide or sotolol
Dronedarone?

Question 22

How do b-blockers work?

Answer 22

They slow conduction through the AV node

Question 23

How do b-blockers work?

Answer 23

They slow conduction through the AV node

Question 24

CAUTION beta blockers are contraindicated with

Answer 24

Diltiazem