AF

Question 1

Classification of AF

Answer 1

1. RECURRENT: Terminates spontaneously without intervention
2. PERSISTENT: non spontaneous termination + need for medical intervention
3. PERMANENT: AF is permanent rhythm + no response to medical intervention

Question 2

ECG findings in AF

Answer 2

QRS: fast + irreg. irreg.

Lack of P waves

Question 3

Causes of AF

Answer 3

PIRATES

Pulmonary embolism / disease / post-op
IHD
Rheumatic heart disease
Anaemia / Alcohol
Thyroid (hyper)
Elevated BP
Sepsis

Question 4

Clinical presentation

Answer 4

Symptoms: 
Asymp
Palps
SOB
CP

Signs:
Irregularly irregular pulse
Pulse deficit (diff. between pulse and HS)

Question 5

Investigations

Answer 5

ECG
Bloods
Echo

Question 6

Scoring systems in AF

Answer 6

CHA2DS2VASC
-Asseses stroke risk. If risk >2 anti-coagulate

HASBLED
- identifies those at risk of significant bleeding on anticoagulant therapy

Question 7

Management of acute AF <48hrs + unstable

Answer 7

CARDIOVERT + VENTRICULAR RATE CONTROL + LMWH

Question 8

Management of paroxysmal AF

Answer 8

CHADSVASC assessment + ‘pill in pocket’ for future episodes (pharmacological cardioversion) + BB to prevent episodes

Question 9

Management of persistent AF

Answer 9

Rhythm control w/ CCB + anticoagulant + cardiovert once anticoagulant established + BB if required after cardioversion