Af

Question 1

What are the three types of drugs you give for someone with AF?

Answer 1

Anticaog (turbulent blood flow, virhcows)
Rate
Rhythm

Question 2

What is the chad vase

Answer 2

Risk of clotting

Question 3

Warfarin avoid in

Answer 3

Pregnancy

Question 4

RenL impairment what not to give

Answer 4

Lmwh

DOAc

Question 5

Rate control - two classes of drugs

Answer 5

Beta blocker e.g. propranolol

CCB

Question 6

CCB types and uses

Answer 6

Amlodipine / nifedipine - dihydropyridine - heart

Verapamil or diltiazem - non di hydro - AF

Question 7

Rhythm control

Answer 7

Electrical - cardioversion, amiodarone
Chemical
Anticoagulant before cardioversion

Question 8

SE of amiodarone

Answer 8

Everything

Question 9

Af with heart failure med

Answer 9

Digoxin (rate and control)

Question 10

Define

Answer 10

Rapid, chaotic and ineffective atrial electrical conduction

Question 11

Classification

Answer 11

Paroxysmal (more than 48 hours)
Permanent (?)
Persistent (more than week)

Question 12

Epidemiology

Answer 12

Elderly - 5% over 65

Question 13

Causes

Answer 13

PIRATES
PE/pericarditis/pneumonia
Ischemia 
Resp conditons 
Atrial myxoma/enlargement
Thyrotoxicosis 
Ethanol (holiday heart)
Sepsis / sleep apemoa

Resp include: bronchial carcinoma, PE

Note also: HTN/mitral valve disease, IHD, rheumatic heart disease, sick sinus syndrome

Question 14

Symptoms

Answer 14

Symptoms of causes
Also palpitations
Syncope
Chest discomfort

Question 15

What would you look for during your examination?

Answer 15

Irregularly irregular pulse
Thyroid disease
Valvular disease

Question 16

Investigations and findings

Answer 16

ECG - absent P wave, irregular QRS complex 
Bloods: 
-Cardiac enzymes
-TFT
-Lipid profile
-U and E
-Mg 
-Calcium
Echo - assess valve disease/left atrial dilation/ventricular dysfunction/structural abnormalities

Question 17

Why do you assess for magnesium and calcium concentrations?

Answer 17

Hypomagnesemia
Hypocalcemia
Hypokalemia

Can all cause increased risk of digoxin toxicity

Question 18

What must you do before cardioversion if the AF has been there for a while?

Answer 18

Anticoagulate

Question 19

What is the time frame of the AF after which you must anticoagulate before cardioversion? How long do you anticoagulate for?

Answer 19

If more than 48 hours

anticoag for 3-4 weeks

Question 20

What is the strength of DC cardioversion?

Answer 20

200J or 2x100J

Question 21

What are the chemical cardioversion options?

Answer 21

Flecainide

Amiodarone

Question 22

Which of these chemical cardioversion drugs is contra-indicated and in what scenario?

Answer 22

Flecainide - contraindicated in IHD

Question 23

If someone has permanent AF, what might you want to give them?

Answer 23

Rate controlling drugs:
Verapamil/digoxin
Beta blockers

Question 24

What migt you give prophylaxically against AF? One of these is also known by a colloquial term - what is this?

Answer 24

Sotalol (BB)

Amiodarone/or flecainide (pill in pocket)

Question 25

For stroke prevention, what drugs do you give to low risk and high risk pt (following chad vasc score)?

Answer 25

Low risk - aspirin

High risk - warfarin

Question 26

Who would these high risk pt be?

Answer 26

Over 75 with HTN
Hx of:
Stroke/embolism
Diabetes
Vascular disease
Valve disease
HF
Impaired left V function

Question 27

Complications

Answer 27

Stroke
Left atrial enlargement
Left ventricular dysfunction
Worsening of any existing HF