AF

Question 1

What are the characteristics of AF?

what is paroxysmal AF

Answer 1

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)

Question 2

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?

Answer 2

persistent

Question 3

long standing PERSISTENT AF is characterised by having af for longer than ?

4 months
6 months
12 months
18 months

Answer 3

12 months

Question 4

persistent AF is characterised as having

Answer 4

continuous > 7 days worth of AF

Question 5

which isn't a risk factor for AF?
HF
VALVULAR HEART DISEASE
CAD
CKD
CUSHINGS
SLEEP APNOEA

Answer 5

CUSHINGS

all the risk factors are;
htn, hf, dm, obesity, sleep apnoea, chronic lung disease, valvular heart disease, chd, cad, thryoid, ckd

Question 6

which investigations should be done if AF suspected?

Answer 6

ECG, (24 hour if parox)
pulse
echo ( transthoracic
transoesophageal echo, to see for any murur abnormalities that may need further IX.)

Question 7

what is the acute management of AF?

Answer 7

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

Question 8

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

Answer 8

long qt sydnrome

g isnt correct because they need to have persistent af as well as those ( also f needs to be persistent too)

Question 9

when should rhythm control favour rate control in chronic AF tx?

Answer 9

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.

Question 10

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

Answer 10

when af has a reversible cause

Question 11

rate control should be used as first line strategy except if:

Answer 11

af has a reversible cause
hf due to af
new onset af
paroxysmal af

Question 12

what are the main methods of controlling the rate?

Answer 12

standard beta blocker (NOT sotalol)
rate limiting ccb (diltiazem)
digoxin only in non paroxysmal af / hf/ sedentary patients.

Question 13

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

Answer 13

c

Question 14

how many points is max on hasbled score?

7
8
9
10

Answer 14

9

Question 15

what do the letters score on hasbled?

Answer 15

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

Question 16

when do you use hasbled?

Answer 16

to work out the modifiable risk factors and improve the safety of anticoagulation

Question 17

hasbled scoring stratification:

Answer 17

0-2 risk of haemmhorage is low

3+ high risk of haemmhorage

Question 18

chadsvasc scoring

Answer 18

c-congestive heart failure
h- hypertension
a-age >75
a- age 65-74
d- dm
s- sex
s-stroke / tia/ thromboembolism
vasc- vascular disease

Question 19

what is the max score for chadsvac?
7
9
11
none of the above

Answer 19

none of the above
it is 10
age > 75 is 2
and so is stroke etc.

Question 20

what is the consequetial rx if anticoagulation is contraindicated?

Answer 20

left atrial appendix occlusion

Question 21

when should stroke risk or bleeding risks be reviewed?

Answer 21

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

Question 22

when are noacs anticoagulants are used ?

Answer 22

> 75
or if they have hypertension
diabetes mellitus
symptomatic heart failure or stroke/tia

Question 23

what does ttr stand for?

Answer 23

Time in therapeutic range.

It’s a percentage showing hoe frequently the inr is within the reference range

Question 24

when does the anticoagulation need to be re-assessed?

Answer 24

if more than 2 values of inr >5 IN 6months or one off value > 8
or ore than 2 values < 1.5

ttr< 65%

Question 25

how often should anticoagulation be reviewed?

Answer 25

at least annually.