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#Phase 2.1: CardioResp > AF > Flashcards

AF Flashcards

1
Q

What are the most common causes of AF? (5 things)

A
  1. S – Sepsis
  2. M - Mitral Valve Pathology
  3. I – Ischaemia HD
  4. T - Thyrotoxicosis
  5. H - HTN

(mrs. SMITH has AF)

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2
Q

What is up with the Atria contraction in AF? (3 things)

A
  1. Uncoordinated
  2. Rapid
  3. Irregular
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3
Q

Why is the atria contraction clarted in AF?

A

Disorganised electrical activity overriding normal SA node activity

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4
Q

How is the pathophysiology of AF reflected in a ECG? (4 things)

A
  1. Irregular rhythm
  2. QRS thinning
  3. P waves missing (lack of coordinated electrical activity)
  4. Isoelectric baseline missing
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5
Q

What does the disorganised electrical activity in atria in AF also lead to?

A

Irregular conduction of electrical impulses to ventricles

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6
Q

What does the irregular conduction of electrical impulses to ventricles caused by AF lead to? (4 things)

A
  1. Irregularly irregular ventricular contractions
  2. Tachycardia
  3. Heart failure bc poor filling of ventricles @ diastole
  4. Risk of stroke
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7
Q

How can AF cause stroke? (4 steps)

A
  1. Uncontrolled organised movement of atria –> thrombus (clot)
  2. Thrombus mobilizes –> embolus
  3. Embolus travels from atria –> ventricle –> aorta –> carotid arteries –> brain
  4. Embolus lodges in cerebral arteries –> ischaemic stroke
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8
Q

Where is the most common site of blood stagnating in the heart?

A

Left atrium, esp atrial appendage (outpouching ting)

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9
Q

What are the clinical features of AF? (6 things)

A
  1. Palpitations
  2. Usually asymptomatic
  3. SOB
  4. Syncope
  5. Irreg irreg pulse
  6. Other assoc conditions symptoms (e.g stroke / sepsis)
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10
Q

What are the differentials of an irregularly irregular pulse? (2 things)

A
  1. AF
  2. Ventricular ectopics
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11
Q

How do you differentiate between AF and Ventricular ectopics? (which both have an irreg irreg pulse)

A

ECG

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12
Q

What diagnosis would a irreg irreg pulse that disappears at high HR (e.g. @ exercise) suggest? (either AF or Ventricular ectopics)

A

Ventricular ectopics bc they disappear when HR goes over a certain threshold

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13
Q

What are the ECG features of a AF? (4 things)

A
  1. Irreg irreg tachycardia rhythm
  2. QRS thinning
  3. P waves missing
  4. Isoelectric baseline missing
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14
Q

What are the principles of treating AF? (2 things)

A
  1. Rate / rhythm control
  2. Anticoag. to prevent stroke
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15
Q

Why is Rate control important in AF?

A

Bc high rate –> less time for ventricles to fill up –> reduced CO

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16
Q

What is the aim of Rate control in AF?

A

Get HR under 100 –> extends diastole time for ventricles to fill up

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17
Q

According to NICE, every AF patient should have Rate control as their first line treatment except when? (4 things)

A
  1. Cause of AF is reversible
  2. New onset AF (last 48 hrs)
  3. AF is causing HF
  4. Still symptomatic after rate controlled
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18
Q

What are the options for Rate control in AF? (3 things)

A
  1. Beta blocker (first line) (atenolol 50-100mg once daily)
  2. Calcium channel blocker (e.g diltiazem) (don’t give in HF)
  3. Digoxin (only in sedentary ppl cah needs monitoring + toxicity risk)
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19
Q

Which AF patients should be offered Rhythm control? (4 things)

A
  1. Cause of AF is reversible
  2. New onset AF (last 48 hrs)
  3. AF is causing HF
  4. Still symptomatic after rate controlled

(basiclly when they shudnt have rate control)

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20
Q

What is the aim of Rhytm control in AF?

A

Return patient to Normal Sinus Rhythm

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21
Q

What are the options for Rhythm control in AF? (2 things)

A
  1. Cardioversion
  2. Long term MEDICAL rhythm control
22
Q

When should Cardioversion be given IMMEDIATELY in AF? (2 things)

A
  1. AF present for less than 48 hrs
  2. Severely haemodynamically unstable
23
Q

When should Cardioversion be given but DELAYED in AF? (2 things)

A
  1. AF present for more than 48 hrs
  2. Pt haemodynamically stable
24
Q

What is the point of DELAYED cardioversion in AF?

A

Allows pt to be anticoagulated for 3 wks first

25
Q

Why is anticoagulation important before cardioversion in AF?

A

Bc pt might have a clot, n returning them to Normal Sinus Rhythm might mobilise clot –> stroke

26
Q

What are the 2 types of Cardioversion in AF?

A
  1. Pharmacological Cardioversion
  2. Electrical Cardioversion
27
Q

What Pharma Cardioversion is first line for AF? (according to NICE) (2 things)

A
  1. Flecanide
  2. Amiodarone
28
Q

What is the aim of Electrical Cardioversion in AF?

A

To shock heart bk into Normal Sinus Rhythm

29
Q

What does Electrical Cardioversion in AF involve? (2 things)

A
  1. Sedation / GA
  2. Cardiac defibrillator –> deliver controlled shocks
30
Q

What are the types of Long term MEDICAL rhythm control options in AF? (3 things)

A
  1. Beta blockers (first line)
  2. Dronedarone (second line) (given after successful cardioversion)
  3. Amiodarone (for pt w HF / L Ventricular dysfunction
31
Q

What is Paroxysmal AF?

A

When AF comes n goes in episodes (not more dan 48hrs)

32
Q

How should Paroxysmal AF be managed?

A
  1. Anticoag based on CHADSVASc score
  2. “Pill in pocket” approach (have pill to stop AF for when dey need)
33
Q

What must patients have to qualify for the “Pill in pocket” approach in Paroxysmal AF? (3 things)

A
  1. Infrequent episodes
  2. No underlying structural heart disease
  3. Be able to identify when dey r in AF
34
Q

What is the pill in the “Pill in pocket” approach for Paroxysmal AF?

A

Flecanide

35
Q

What is the risk of an AF pt WITHOUT anticoag. suffering a stroke?

A

5% stroke risk per year

36
Q

What is the risk of an AF pt WITH anticoag. suffering a stroke?

A

1-2% stroke risk per year

37
Q

What is the risk of a patient on anticoag suffering a serious bleed?

A

3% risk of serious bleed each year

38
Q

What types of Anticoagulant are used for AF? (2 things)

A
  1. Warfarin
  2. NOvel AntiCoagulants (NOACs)
39
Q

How does Warfarin act as an anticoagulant? (2 points)

A
  1. Vit K antagonist (vit K = important for clotting factors)
  2. Prolongs prothrombin time (time it takes blood to clot)
40
Q

What measurement is used to assess how anticoagulated a patient is by Warfarin?

A

INR (international normalised ratio)

41
Q

What is the INR a calculation of?

A

Prothrombin time in comparison w normal adult

42
Q

What does an INR of 1 or 2 suggest?

A

INR: 1 = normal prothrombin time
INR: 2 = prothrombin time is twice that of normal adult (watery)

43
Q

What are examples of NOACs (anticoag used in AF)? (3 things)

A
  1. Apixaban (twice daily)
  2. Rivaroxaban (once daily)
  3. Dabigatran (twice daily)
44
Q

If there’s uncontrolled / life threatening bleeding from using NOACs, how can you reverse their effects?

A
  1. Andexanet alfa (for apixaban n rivaroxaban)
  2. Idarucizumab (for dabigatran)
45
Q

What are the advantages of NOACs over Warfarin? (BMJ) (4 things)

A
  1. No monitoring needed
  2. No major interaction
  3. Better at preventing strokes in AF
  4. Less risk of bleeding
46
Q

What is used to see the risk of a AF pt has a risk of stroke and should be anticoagulated?

A

CHA2DS2Vasc score

47
Q

What does a score of 0,1,1+ CHA2DS2Vasc score suggest?

A 
0 = no risk of stroke, no anticoag. 
1 = consider anticoag. 
1+ = offer anticoag.
48
Q

What do the letters in CHA2DS2Vasc mean and what do they score?

A
  • C – Congestive HF (1)
  • H – HTN (1)
  • A2 – Age >75 (Scores 2)
  • D – Diabetes (1)
  • S2 – Stroke / TIA previously (Scores 2)
  • V – Vascular disease (1)
  • A – Age 65-74 (1)
  • S – Sex (female) (1)
49
Q

What is the opposite of the CHA2DS2Vasc score?

A

HAS-BLED

50
Q

What does the HAS-BLED score show?

A

Pt risk of BLEEDING while on anticoag.

51
Q

What do the letters in HAS-BLED mean and what do they score?

A

• H – Hypertension (1)
• A – Abnormal renal / liver function (1 each)
• S – Stroke (1)
• B – Bleeding (1)
• L – Labile INRs (labile = unstable) (whilst on warfarin) (1)
• E – Elderly (65+) (1)
• D – Drugs or alcohol (1 each)
Score of 3+ = high risk of bleeding

#Phase 2.1: CardioResp (28 decks)

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