a fib

Question 1

how many beats of atria

Answer 1

300-600

Question 2

is the ventricualr rate the same as the atrial node

Answer 2

Delay at the atrioventricular node means that only some of the atrial impulses are conducted to the ventricle

Question 3

RF

Answer 3

anything that stretches the atria or causes fibrosis of atria

AGE - increasing

Question 4

causes

Answer 4

divided into cardiac and non cardiac

cardiac
- ischemic heart disease
- hypertension
-Rheumatic heart disease
-myocarditis/peri

non cardiac
dehydration
resp - pneumonia or PE
- hyperthyrodism
- electrolyte (hypokalemia)

Question 5

classification

Answer 5

Acute (lasts <48 hours)
Paroxysmal (lasts <7 days and is intermittent)
Persistent (lasts >7 days but is amenable to cardioversion)
Permanent (lasts >7 days and is not amenable to cardioversion)

Question 6

complications

Answer 6

heart failure
stroke

Question 7

signs /diagnosis

Answer 7

pulse deficit

ECG

Question 8

FAST A FIB

Answer 8

When ventricular rate is >100bpm it is considered to be fast AF which normally warrants some level of immediate treatment.

Question 9

TX

Answer 9

DC CARDIOVERSION - if unstable
Consider reversible causes
Infection: Give antibiotics and fluids (sepsis, pneumonia)
Dehydration: Give fluids
Replace abnormal electrolytes

rememebr 5H’s and 4 t’s

if no reversible if known

then 1st line is RATE CONTROL (but has CI)

Question 10

RATE CONTROL

Answer 10

usually first line except

• Whose AF has a reversible cause.
  Who have heart failure thought to be primarily caused by AF.
  With new-onset AF.
  For whom a rhythm control strategy would be more suitable based on clinical judgement.

bb or ca 2 blocker

Question 11

most coomlmy used bb

Answer 11

bisoprolol

Question 12

CI bb

Answer 12

asthma and copd
hypotension

Question 13

examples of non dhp importnant NB about them

Answer 13

diltiazem + verapamil

not commonly used because they are negatively inotropic

Question 14

digoxin

Answer 14

Usual for patients who are hypotensive or have co-existent heart failure
Should be avoided in younger patients because it increases cardiac mortality.
Often used second-line in conjunction with beta-blockers if fast AF remains refractory.

Question 15

Rhythm control and nb note

Answer 15

Rhythm control can be achieved via two methods:

Electrical cardioversion
Pharmacological cardioversion

people who have chronic AF are unlikely to be successful with cardioversion OR people who have been cardioverted before to no avail

Question 16

how would you manage a patient with a new onset AF thats acute

Answer 16

f the AF is acute (<48 hours) then the patient can be DC cardioverted with sedation.

Question 17

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