AF

Question 1

Acute management of AF?

Answer 1

A-E

Pt unstable:
1st line: synchronised DC cardioversion +/-amiodarone.

Pt stable + onset of AF <48 hours:
Offer rate or rhythm control.

Rhythm control:
- DC cardioversion (+ sedation)
OR
- pharmacological anti-arrhythmics (FLEICANIDE if no structural heart disease, AMIODARONE if hx of structural heart disease).
- if DC cardioversion is delayed then heparin will be required to anticoagulate the pt.

Pt stable + onset of AF >48 hours/unclear time of onset:
Offer rate control only.
- BB, diltiazem (CCB) or digoxin.
- anticoagulate for 3/52 prior to attempting cardioversion

Anticoagulation options:
- DOACs
- warfarin
- lmwh (enoxaparin)

Question 2

Management of chronic AF?

Answer 2

Tx depends on symptoms and stroke prevention.

Rate control:
1st line: BB (bisoprolol) or CCB (diltiazem or verapamil)
2nd line: dual therapy (BB + CCB)
Digoxin monotherapy (inactive pts with non-paroxysmal AF

Rhythm control:
Electrical cardioversion
Pharmacological cardioversion: amiodarone, fleicanide (PILL IN THE POCKET) or sotalol.
Catheter ablation (last resort)

Rhythm control is only offered if onset <48hrs and if pt has undergone 3/52 of anticoagulation or has had a TOE to exclude a mural thrombus.
- due to high risk of stroke when the heart returns to sinus rhythm.

Question 3

What is rate control?

Answer 3

Reduce a patient’s heart rate in order to reduce symptoms.

Question 4

What is rhythm control?

Answer 4

Revert a patient back into sinus rhythm.

Question 5

Presentation of AF?

Answer 5

Palpitations
Chest pain
Shortness of breath
Lightheadedness
Syncope
Irregularly irregular pulse
Apical to radial pulse deficit

Question 6

Causes of AF?

Answer 6

Ischaemic heart disease
HTN
Rheumatic heart disease
hyperthyroidism
pneumonia or pulmonary embolism
alcohol abuse
hypokalaemia, hypomagnesaemia