AF

Question 1

-How common is AF?

Answer 1

-Most common sustained arrhythmia, increasing prevalence
-More common in the elderly and males

Question 2

What causes AF?

Answer 2

-CHD
-HTN
-Valvular heart disease
-Hyperthyroidism
-11% have an unknown cause (lone AF)

Question 3

What risk factors are there for AF?

Answer 3

-Common cardiac risks eg rheumatic disease, pre-excitation syndromes, congenital bicuspid valves, heart failure
-Less common cardiac eg cardiomyopathy, pericarditis, congenital heart disease, atrial septal defect
-Non-cardiac eg drugs (bronchodilators, thyroxine), acute infection, electrolyte depletion, PE, DM
-Dietary and lifestyle eg excessive alcohol, caffeine, obesity

Question 4

How does AF present?

Answer 4

-Irregularly irregular pulse
-SOB
-Palpitations
-Chest discomfort
-Syncope / dizziness
-TIA / stroke

Question 5

What are the differential diagnoses for AF?

Answer 5

-Atrial flutter
-SVT
-WPW
-Ventricular tachycardia

Question 6

How would you investigate this patient?

Answer 6

-ECG (diagnostic except in paroxysmal AF)
–Variability in R-R intervals
–Absence of P waves
-TFTs, FBC, U+Es, LFTs, coagulation screen
-CXR - structural causes
-Echo if unclear after above completed

Question 7

What treatment might you offer someone with AF?

Answer 7

-Anti-arrhythmics eg amiodarone (short-term), CCB, digoxin, BB
-CHA2DS2VASc score to decide whether to give anti-thrombotic treatment
-ORBIT tool to decide whether to give anticoagulants
-DOAC 20mg, warfarin
-Treat underlying cause eg infection
-Treat associated HF