Af Flashcards
What are the three types of drugs you give for someone with AF?
Anticaog (turbulent blood flow, virhcows)
Rate
Rhythm
What is the chad vase
Risk of clotting
Warfarin avoid in
Pregnancy
RenL impairment what not to give
Lmwh
DOAc
Rate control - two classes of drugs
Beta blocker e.g. propranolol
CCB
CCB types and uses
Amlodipine / nifedipine - dihydropyridine - heart
Verapamil or diltiazem - non di hydro - AF
Rhythm control
Electrical - cardioversion, amiodarone
Chemical
Anticoagulant before cardioversion
SE of amiodarone
Everything
Af with heart failure med
Digoxin (rate and control)
Define
Rapid, chaotic and ineffective atrial electrical conduction
Classification
Paroxysmal (more than 48 hours)
Permanent (?)
Persistent (more than week)
Epidemiology
Elderly - 5% over 65
Causes
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
Symptoms
Symptoms of causes
Also palpitations
Syncope
Chest discomfort
What would you look for during your examination?
Irregularly irregular pulse
Thyroid disease
Valvular disease
Investigations and findings
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
Why do you assess for magnesium and calcium concentrations?
Hypomagnesemia
Hypocalcemia
Hypokalemia
Can all cause increased risk of digoxin toxicity
What must you do before cardioversion if the AF has been there for a while?
Anticoagulate
What is the time frame of the AF after which you must anticoagulate before cardioversion? How long do you anticoagulate for?
If more than 48 hours
anticoag for 3-4 weeks
What is the strength of DC cardioversion?
200J or 2x100J
What are the chemical cardioversion options?
Flecainide
Amiodarone
Which of these chemical cardioversion drugs is contra-indicated and in what scenario?
Flecainide - contraindicated in IHD
If someone has permanent AF, what might you want to give them?
Rate controlling drugs:
Verapamil/digoxin
Beta blockers
What migt you give prophylaxically against AF? One of these is also known by a colloquial term - what is this?
Sotalol (BB)
Amiodarone/or flecainide (pill in pocket)
For stroke prevention, what drugs do you give to low risk and high risk pt (following chad vasc score)?
Low risk - aspirin
High risk - warfarin
Who would these high risk pt be?
Over 75 with HTN Hx of: Stroke/embolism Diabetes Vascular disease Valve disease HF Impaired left V function
Complications
Stroke
Left atrial enlargement
Left ventricular dysfunction
Worsening of any existing HF
