AF Flashcards
What are the characteristics of AF?
what is paroxysmal AF
CARDIAC arrhythmia with irregular RR intervals, , no p waves and rapid and chaotic irregular atrial activity.
paroxysmal AF: > 2 episodes of AF that terminate within 7 days and (less than or equal to 48 terminated with CV)
becky has palpitations that have lasted for 2 hours at a time and she has had them every week for the past 7 months .
what kind of AF DOES she have?
persistent
long standing PERSISTENT AF is characterised by having af for longer than ?
4 months
6 months
12 months
18 months
12 months
persistent AF is characterised as having
continuous > 7 days worth of AF
which isn't a risk factor for AF? HF VALVULAR HEART DISEASE CAD CKD CUSHINGS SLEEP APNOEA
CUSHINGS
all the risk factors are;
htn, hf, dm, obesity, sleep apnoea, chronic lung disease, valvular heart disease, chd, cad, thryoid, ckd
which investigations should be done if AF suspected?
ECG, (24 hour if parox)
pulse
echo ( transthoracic
transoesophageal echo, to see for any murur abnormalities that may need further IX.)
what is the acute management of AF?
acbde: stabilise
check their U+E
emergency electrical cardioversion
or chemical cardioversion (IV AMIODARONE / FLECAINIDE)
(if they had an mi/pneumonia induced AF give verapamil/ bisoprolol)
then anticoagulate with lmwh, or warfarin if high risk emboli
If someone has chronic AF; when don’t they get treated with rhythm control?
a) have paroxysmal af
b) if they have persistent AF and they’re 29
c) if they have lone af, and present first time with AF
d) have long qt syndrome
e) if they are symptomatic
f) if they had af induced by a treated infection (secondary af)
g) b,d,c,e
long qt sydnrome
g isnt correct because they need to have persistent af as well as those ( also f needs to be persistent too)
when should rhythm control favour rate control in chronic AF tx?
if they have permanent AF or persisten af and - patient is over 65, -patient has coronary artery disease cant tolerate anti arrhythmics unsuitable for cardioversion.
when isn’t rate control the first line strategy?
a) when af has reversible cause
b) if have permanent af
c) if they have persistent and cad
d) they have persistent and >65
when af has a reversible cause
rate control should be used as first line strategy except if:
af has a reversible cause
hf due to af
new onset af
paroxysmal af
what are the main methods of controlling the rate?
standard beta blocker (NOT sotalol)
rate limiting ccb (diltiazem)
digoxin only in non paroxysmal af / hf/ sedentary patients.
what does the A, the L and D in hasbled stand for?
alcohol, liver function, diabetes
abnormal liver function, labile inr, diabetes
abnormal liver function , labile inr, drugs/alcohol
age, liver function, drugs/alcohol
c
how many points is max on hasbled score?
7
8
9
10
9
what do the letters score on hasbled?
h-hypertension - 1 a- abnormal liver function / renal function 1/2 s- stroke 1 b- bleeding 1 l-labile inr 1 e- elderly age (>65) 1 d (drugs or alcohol) 1/2
when do you use hasbled?
to work out the modifiable risk factors and improve the safety of anticoagulation
hasbled scoring stratification:
0-2 risk of haemmhorage is low
3+ high risk of haemmhorage
chadsvasc scoring
c-congestive heart failure h- hypertension a-age >75 a- age 65-74 d- dm s- sex s-stroke / tia/ thromboembolism vasc- vascular disease
what is the max score for chadsvac? 7 9 11 none of the above
none of the above
it is 10
age > 75 is 2
and so is stroke etc.
what is the consequetial rx if anticoagulation is contraindicated?
left atrial appendix occlusion
when should stroke risk or bleeding risks be reviewed?
if not taking anticoagulants do it annually
if they develop ( dm, hf, chd, pad, stroke ) do it at any time they develop it
for stroke risk if age>65
when are noacs anticoagulants are used ?
> 75
or if they have hypertension
diabetes mellitus
symptomatic heart failure or stroke/tia
what does ttr stand for?
Time in therapeutic range.
It’s a percentage showing hoe frequently the inr is within the reference range
when does the anticoagulation need to be re-assessed?
if more than 2 values of inr >5 IN 6months or one off value > 8
or ore than 2 values < 1.5
ttr< 65%
how often should anticoagulation be reviewed?
at least annually.
