6pm series

Question 1

what is the most common cause of persistent AF?

• ht
• valvular disease
• ihd
• alcohol and caffeine
• post operative

Answer 1

hypertension

- more people with ht than ihd

Question 2

holiday heart syndrome

Answer 2

alcohol and caffeine use putting heart into arrthymias

Question 3

permanent AF

Answer 3

• continuous AF > 1 year
• resistant to cardioversion
• rate control strategy is adopted

Question 4

58 y/o, intermittent palptiations, lasting 30 mins at a time, heart racing, never dizzy nor lightheaded, not lost consciousness or collapsed.

already had 12 lead ECG.

t2dm, htn, gout

BMI 39, palpitation of his radial pulse. sinus rhythm at 80bpm.

Answer 4

order outpatient 24hour tape

Question 5

investigating AF

Answer 5

performing transthoracic echocardiogram.

Question 6

types of AF

Answer 6

paroxysmal

persistent

permanent

Question 7

rhythm control

Answer 7

pharma
- tablets

electrical
- ablation

Question 8

48 y/o male, ED with palpitations started at 6pm post hot curry. racing irreg heart beat with no chest pain. usually fit and well.

no abnormalities on echo 4 months ago.

patient on AF.

trial of vagal manoeuvres is commenced to no effect

most appropriate first line management

• digoxin loading dose
• bisoprolol 5mg po STAT
• amiodarone 5mg/kg IV infusion
• flecainide 200 mg po STAT
• adenosine 6mg IV rapid bolus

Answer 8

bisoprolol 5mg po STAT

first line management.

Question 9

78 y/o to GP to discuss known persistent AF. routine ECHO shows enlarged LA with preserved ejection fraction.

dx - warfarin, oral bisoprolol

trial of digoxin was unsuccessful

Answer 9

refer to cardiology - needs consideration of AF ablation

Question 10

sotalol

Answer 10

• beta blocker, works in a slightly different way

Question 11

basic mechanism of the action of amiodarone

Answer 11

k channel blockers

Question 12

adenosine

Answer 12

transient blockage of conduction at AV node

Question 13

digoxin

Answer 13

na/k atp-ase pump

Question 14

84 y/o recently diagnosed with AF post ischaemic stroke.

pmh - gout, ht, severe asthma, early onset dementia

dx - clopidogrel, simvastatin , salbutamol, clenin modulate, allopurinol, ramipiril

most appropriate medication to manage rate?

Answer 14

diltiazem

people with severe asthma can’t have bblockers.

Question 15

hasbled score

Answer 15

persons risk of bleeding being put on anticoagulation

Question 16

69 y/o female, recent diagnosis of AF. attened to discuss anticoagulation

PMH - recurrent UTI, simple hernia, mild o.arthritis in knees.

generally fit and well.

avoids doctors, does not like taking tablets.

Chadsvasc score - 1
hasbled - 1

would you give her?

• warfarin
• apixaban
• rivaroxaban
• dabigatran
• aspirin

Answer 16

low risk of bleedings.

reccomended to start anticoagulation mediation

give rivaroxoban
- once daily preparation

Question 17

69 y/o female, recent diagnosis of AF. attened to discuss anticoagulation

PMH - recurrent UTI, simple hernia, mild o.arthritis in knees.

generally fit and well.

avoids doctors, does not like taking tablets.

Chadsvasc score - 1
hasbled - 1

would you give her?

• warfarin
• apixaban
• rivaroxaban
• dabigatran
• aspirin

Answer 17

low risk of bleedings.

reccomended to start anticoagulation mediation

give rivaroxoban

• once daily preparation
• must be taken with food, no monitoring

Question 18

where and why is BNP released?

Answer 18

stretching from left ventricle causes BNP release from cardiac myocytes.