AF

Question 1

What are the 3 types of AF? And how are they categorised?

Answer 1

1. Paroxysmal - spontaneously resolves 7/7 and needs rx to resolve
2. Permanent - constant & unresponsive to cardioversion

Question 2

What are 8 common causes of AF?

Answer 2

CHD, MI, PE, mitral disease, hyperthyroidism, post-op, low K, low Mg

Question 3

Name 4 common symptoms of AF?

Answer 3

Chest pain
Palpitations
Dyspnoea
Faintness

Question 4

What are the clinical features of AF?

Answer 4

Irreg/irreg pulse
Variable 1st HS intensity
Signs of LVF eg. Peripheral oedema
Signs of underlying, causative disease

Question 5

Which investigations would you perform & why?

Answer 5

ECG - AF shows absent P waves & irregular rhythm
U&Es - electrolyte issues, renal function
Trop I - evidence of MI
TFTs - hyperthyroidism
Echo - once HR controlled can measure LV function & show valvular or structural abnormalities

Question 6

What is the management of acute, symptomatic AF?

Answer 6

1. Treat causal factors
2. LMWH eg. Enoxaparin
3. Rate control with beta-blocker eg. Metoprolol IV
4. ITU/CCU for cardioversion

Question 7

What is the management of chronic AF?

Answer 7

1st Line - beta-blocker (eg. Bisoprolol) or rate limiting ca antagonist (eg. Verapamil or diltiazem)
2nd Line - add in digoxin for AF with ADL or Ca Ant + digoxin if AF during exercise.

Warfarin is used for thromboprophylaxis