AF

Question 1

What is it?

Answer 1

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia resulting from irregular, disorganized electrical activity and ineffective contraction of the atria.

Question 2

Aetiology

Answer 2

Rapidly firing foci, most commonly within the pulmonary vein. These triggers cause propagating wavelets, which may lead to re-entrant circuits in abnormal atrial myocardium.

Causes: HF, valvular disease, WPW, infection, PE, excessive caffeine, alcohol, obesity, smoking

Question 3

Symptoms

Complications?

PMH increasing suspicion?

Answer 3

Suspect atrial fibrillation (AF) in people with an irregular pulse, with or without any of the following:
Breathlessness.
Palpitations.
Chest discomfort.
Syncope or dizziness.
Reduced exercise tolerance, malaise/listlessness, decrease in mentation, or polyuria.

A potential complication of AF, such as stroke, transient ischaemic attack, or heart failure.

Past medical history that may further raise suspicion of AF includes:
Cardiac disease (including valvular heart disease, coronary artery disease, hypertension, pericarditis, cardiomyopathy, and other arrhythmias) and/or recent cardiothoracic surgery.
Non-cardiac conditions including diabetes, thyroid disease, cancer, and alcohol misuse.

Question 4

Classification

Answer 4

Paroxysmal AF — episodes lasting longer than 30 seconds but less than 7 days (often less than 48 hours) that are self-terminating and recurrent.
Persistent AF — episodes lasting longer than 7 days (spontaneous termination of the arrhythmia is unlikely to occur after this time) or less than seven days but requiring pharmacological or electrical cardioversion.
Permanent AF — AF that fails to terminate using cardioversion, AF that is terminated but relapses within 24 hours, or longstanding AF (usually longer than 1 year) in which cardioversion has not been indicated or attempted (sometimes called accepted permanent AF).

Question 5

Investigations

Answer 5

Rule out
Other cardiac causes using ECG, ECHO
Other resp causes using CXR
Systemic causes - Bloods

Question 6

Advice

Answer 6

Weight loss,

Question 7

Hospital Admission

Answer 7

Urgently admit to an acute medical unit for emergency electrical cardioversion if the person is exhibiting signs and symptoms of haemodynamic instability, such as a rapid pulse (greater than 150 beats per minute) and/or low blood pressure (systolic blood pressure less than 90 mmHg), loss of consciousness, severe dizziness or syncope, ongoing chest pain, or increasing breathlessness .

Question 8

Advice

Answer 8

Weight loss, stroke awareness, no flying restrictions if stable, inform DVLA themselves,

Question 9

Monitoring/ follow up

Answer 9

Within 1 week of starting rate-control treatment