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Cardiology > AF > Flashcards

AF Flashcards

1
Q

How do you identify Left Ventricular Hypertrophy on an ECG?

A
  • very tall R waves
  • ST depression
  • Over 3 leads
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2
Q

What are signature AF ECG landmarks?

A

Absence of P waves

-Irregularly irregular

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3
Q

What are the three types of AF?

A

paroxysmal, persistent or permanent

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4
Q

What is paroxysmal AF usually associated with?

A

normal hearts

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5
Q

What is chronic AF usually associated with?

A

heart disease

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6
Q

What are the characteristics of sustained AF?

A

It is facilitated by increased parasympathetic tone.

  • decreased refractory periods
  • shorter wave lengths
  • making it easier for AF to sustain itself
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7
Q

What is the mechanism of AF?

A
  • Atria is firing away rapidly
  • muscle layer in atrium is often diseased
  • caused by multiple wavelets of re-entry
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8
Q

How do we stop AF?

A
  • electrical cardioversion (technique where deliver high voltage across the atria to reset the rhythm to voltage 0 of action potential)
  • anti arrythmatic drugs
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9
Q

What are the characteristics of paroxysmal AF?

A
  • paroxysmal and lasting less than 48 hours

- often recurrent

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10
Q

What are the characteristics of persistent AF?

A
  • an episode of AF lasting more than 48hours, which can still be cardioverted to NSR
  • unlikely to spontaneously revert back to NSR
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11
Q

What are the characteristics of permanent AF?

A

-inability to restore NSR

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12
Q

What are some of the associated diseases/causes of AF?

A

-hypertension
-congestive heart failure
-CHD
-obesity
Thyroid disease
-Genetic
-cardiac valve disease

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13
Q

What is Lone (idiopathic) AF

A

Absence of any heart disease and no evidence of ventricular dysfunction
essentially dont know what causes it

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14
Q

What are the symptoms of AF?

A
  • palpitations
  • pre syncope
  • syncope
  • chest pain
  • dyspnoea
  • sweatiness
  • fatigue
  • asymptomatic
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15
Q

How does AF look on an ECG?

A
  • fast atrial rate
  • irregularly irregular
  • absence of P waves
  • Presence of f waves
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16
Q

What is the ventricular rate dependant on in AF?

A
  • Av node conduction properties
  • sympathetic and parasympathetic tone
  • presence of drugs which act on the AV node
17
Q

What are some abnormal patterns of AF?

A

Alow VR rate with periods of fast VR. A pacemaker may be needed to allow control of fast VR. It could result in complete heart block
-treat with pacemaker and B blocker

18
Q

What is pseudo-regularisation AF?

A

a fake regular heart rate AF

19
Q

What are some important points to consider about AF?

A
  • decreased diastole leads to reduced CO
  • can result in congestive HF especially in diastolic dysfunction
  • VR less than 60 suggest AV conduction disease
20
Q

What are the management options for AF?

A
  • rhythm control or rate control
  • anti-coagulation for both approaches if high risk for thromboembolism
  • manage risk and symptoms
21
Q

What are the treatment options to slow down AV node conduction and therefore slow rate in AF ?

A

digoxin, B blockers, verapamil, diltilazem

-use these drugs alone or in combination

22
Q

What are the treatment options to revert AF to sinus rhythm?

A
  • antiarrythmatic drugs

- direct current cardioversion

23
Q

What are the treatment options to maintain normal sinus rhythm?

A
  • anti-arrythmatic drugs
  • catheter ablation of atrial focus/ pulmonary veins
  • surgery
24
Q

What are the four classes of antiarrhythmatic drugs?

A

1, 2, 3 ,4

25
Q

What is a class 1 anti- arrythmatic drug?

A
  • reducing Na channel current

- Lignocaine, quinidine, felcainide, propadenone

26
Q

What is a class II ant arrythmatic drug?

A
  • adrenergic antagonists

- propanolol

27
Q

What is a class III anti arrythmatic drug?

A
  • action potential prolongation

- aminodarone, sotalol, dronedarone

28
Q

What is a class IV anti arrythmatic drug?

A
  • ca channel antagonists

- verapamil

29
Q

what puts you at a high risk of thromboembolism?

A
  • valvular heart disease
  • age above 75 especially if female
  • hypertension
  • heart failure
  • previous thromboembolism or stroke
  • CAD or diabetes and above 50y/old
  • Thyrotoxicosis
30
Q

Should you have any of risk factors for thromboembolic disease then what medication should you be on?

A

Anticoagulants ie warfarin, rivaroxaban

31
Q

What are indications for anticoagulation in valvular AF?

A

-mitral valve disease: Mitral Stenosis and Mitral regurgitation

32
Q

What are indications for anticoagulation in non valvular AF?

A
  • age above 75
  • hypertension
  • HF
  • previous stoke/thromboembolism
  • CAD/DM
  • Diabetes
33
Q

What is indicated by a 1 or 2 on the CHA2DS2-VASc score?

A

1- anticoagulation should be considered

2-they should be on anticoagulation

34
Q

when would radiofrequency ablation in AF be used?

A
  • To maintain SR by ablating AF focus

- For rate control by ablation of the AV node to stop fast conduction to the ventricles

35
Q

What is an atrial flutter?

A

-regular and regular form of atrial tachycardia
-usually paroxysmal
-sustained by a macro-re-entrant circuit
-circuit is confined to the rigtht atrium
-episodes can last from seconds to years
-chronic atrial flutter usually progresses to atrial fibrillation
May result in thromboembolism

36
Q

What are the characteristics on an ECG in atrial flutter?

A
  • atrial 300bpm
  • ventricular rate usually half that
  • saw tooth P wave pattern
  • normal QRS
  • normal conduction sometimes 2:1
  • regular rhythm but may be variable
37
Q

What are the treatment options for atrial flutter?

A

-radiofrequency ablation
-pharmacological therapy
-cardioversion
warfarin for thromboembolic prevention

38
Q

What are the two goals in atrial flutter?

A
  • -Terminate the flutter and prevent recurrence

- Control the ventricular response during the arrhythmia

39
Q

What are the pharmacological therapies used in AF in aim of?

A
  • slow the Ventricular rate
  • restore sinus rhythm
  • maintain sinus rhythm once converted

Cardiology (32 decks)

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