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Year 4 General Medicine > AF > Flashcards

AF Flashcards

1
Q

Causes of AF

A 
SMITH
Sepsis 
Mitral regurgitation 
Ischaemic heart disease 
Thyrotoxicosis 
Hypertension
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2
Q

what are the principles to treating AF

A

rate control
rhythm control
consider anticoagulation

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3
Q

AF is the most common important arrhythmia, true or false

A

true

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4
Q

what are the types of AF

A

permanent - never getting out of it
persistent - succeed in getting out of it
paroxysmal - episodic

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5
Q

paroxysmal can become persistent

A

yes

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6
Q

once you start the AF journey, you will end up in permanent AF, true or false

A

true

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7
Q

describe permanent AF

A

in it
stuck in it
cardiologist will not be able to get you out of it

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8
Q

if you develop AF at >65yr, most cardiologists will treat it as permanent AF

A

yes

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9
Q

symptoms of permanent AF

A 
asymptomatic 
fatigue 
loss of exercise tolerance 
palpitations 
shortness of breath 
exacerbation of heart failure 
angina if IHD 
stroke
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10
Q

sick sinus syndrome

‘tachy brady’

A

patients can have tachy and brady cardia
tachy - usually AF
brady - other heart rhythms
if brady is profound enough, may get syncope

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11
Q

atrial rate of AF

A

300-600bpm

AVN is protective of this

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12
Q

treatment goals for permanent AF

A

control ventricular rate

  1. B blocker: bisoprolol > atenolol
  2. rate limiting CCB: verapamil, diltiazem
  3. +- digoxin
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13
Q

bisoprolol indications

A

arrhythmias and HR control
angina
heart failure

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14
Q

high dose B blockers are used to treat HF?

A

no, high doses can make it worse therefore start it at a very low dose (1.25mg) then add 1.25mg every 2 weeks and build it up very slowly to max tolerated dose

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15
Q

bisoprolol dose for AF

A

5mg to 10mg in 1 step
quicker titration for AF
(not low dose for HF)

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16
Q

if someone is asthmatic, what drug do you use for permanent AF

A

rate limiting CCB
verapamil
diltiazem

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17
Q

digoxin function

A

acts on ATP Na/K pump at AV node

switches on parasympathetics to slow down the heart

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18
Q

in a ‘healthy’ individual, sympathetic drive tends to overcome effect of digoxin

A

yes
exercise/running
digoxin is not good for a young/active person in permanent AF
as does pain, anaemia, HF exacerbation in older patients
therefore treat the cause of the bad HR

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19
Q

dihydropyriDINE CCB examples

A

amloDIPINE

nifeDIPINE

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20
Q

Bisoprolol and verapamil?

A

verapakill

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21
Q

‘auricular’ appendages

A

extra features on atria of heart

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22
Q

Virchows triad

A

hypercoaguability
stasis
endothelial damage

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23
Q

where are you most likely to form a clot in AF

A

left atrial appendage

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24
Q

perforating lingual artery

A

supplies Broca’s area

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25
Q

INR target for warfarin

A

2-3

26
Q

examples of DOACs

A

edoxiban
rivaroxiban
apixiban
dabigatran

27
Q

DOAC drug of choice for AF

A

edoxiban

28
Q

DOAC for PE

A

rivaroxiban

29
Q

DOACs need monitoring blood tests?

A

No

30
Q

CHA2DS2VASc score

A 
congestive heart failure 
hypertension 
Age >75 or 65-74 
diabetes
stroke / TIA
vascular disease - MI, PVD 
Sex category - ignore female risk unless there is another risk
31
Q

score of 2 on CHA2DS2VASc score needs anticoagulation

A

yes

32
Q

indications for warfarin

A

metallic heart valves

APLS

33
Q

LMWH indications for anticoagulation in AF

A

when warfarin INR is subtherapeutic

or prior to operation

34
Q

warfarin is teratogenic

A

yes

35
Q

risk of long term LMWH

A

osteoporosis

36
Q

what is the HASBLED score

A

risk of bleeding if you are anticoagulated

37
Q

persistent AF

A

you’re in it and stuck in it unless a cardiologist is successful in getting out of it

38
Q

goal in persistent AF

A

rhythm control

cardioversion

39
Q

cardioversion in AF

A

one heart rhythm into another

ie from AF to sinus rhythm

40
Q

types of cardioversion

A

pharmacological

electrical DC

41
Q

how does DCC work

A

enough electrical activity to depolarise all heart cells in hope that the SAN reemerged first to restore sinus rhythm
put them under GA

42
Q

risk of DCC

A

arrhythmia: bradycardia, VF

stroke - release of clot from atria

43
Q

within what duration can you attempt cardioversion

A

<48 hr NICE
<24 hr SIGN
<12 hr PC

44
Q

class I antiarrhythmic

A

flecainide

45
Q

class III antiarrhythmic

A

amiodarone

ami’wonder’one

46
Q

amiodarone is very toxic to the skin, true or false

A

true
extravasation - leaking of fluid
can causes severe skin necrosis
therefore some units only allow IV amiodarone into a central line

47
Q

what arrhythmias can flecainide cause

A

VT

atrial flutter

48
Q

what questions do you use to screen whether to use flecainide

A

are you old >65?

do you have anything else wrong with your heart?

49
Q

management of acute AF in the middle of the night

A

IV flecainide
fast patient in case of anaesthesia
LMWH
ECG in the morning

50
Q

management of AF >48 hours

A

start DOAC anticoagulation
then 5-6 weeks later you do elective DCC
keep them on anticoagulation for 1-6months
also consider rate control with B blocker

51
Q

paroxysmal AF is a trouble to treat

A

yes

52
Q

management goals of paroxysmal AF

A

maintain sinus rhythm

maintain AF

53
Q

explain maintaining AF in paroxysmal AF

A

instead of chopping and changing in and out of AF this can be very symptomatic and troublesome, leave them in AF and treat as permanent

54
Q

management of paroxysmal AF in younger patients

A

antiarrhythmic drugs to stay in sinus rhythm
- bisoprolol
- flecainide (if not old or has other heart conditions)
therefore: low dose of each of these in combination
(bisoprolol to protect against flutter and flecainide for AF)
- propafinone (Ic and B blocker combo drug)
- dronedarone
- amiodarone
- sotalol (B blocker + amiodarone)

55
Q

side effects of B blockers

A

cold peripheries
poor sleep
fatigue

56
Q

digoxin is better for permanent/paroxysmal AF

A

digoxin is better for permanent AF rather than paroxysmal

57
Q

flecainide can cause atrial flutter

A

yes

enhances conduction at AVN and can come in with atrial flutter despite AF being controlled

58
Q

what is pill in the pocket

A

can self administer flecainide within a certain timeframe for paroxysmal AF to avoid long term effects
need to try normal therapy first

59
Q

side effects of amiodarone

A 
photosensitivity 
thyroid abnormalities 
grey waxy complexion 
irreversible pulmonary fibrosis 
liver
skin necrosis
60
Q

non-pharmacological management of paroxysmal AF

A

venous access catheter - electrical
radiofrequency ablation around pulmonary veins
RF PVI - pul vein isolation
create a burn electrical activity cannot escape
cold cryo ablation

61
Q

management of atrial flutter

A

same as AF

62
Q

atrial flutter caveats

A

harder to control ventricular rate

more likely to respond to electrical therapy

Year 4 General Medicine (16 decks)

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