AF history & management

Question 1

associated symptoms in SOCRATES

Answer 1

SOB
palpitations
chest pain
syncope
dizziness
recent TIA/stroke
exercise-induced symptoms/exercise tolerance
caffeine intake
drug hx
FHx

Question 2

PMH

Answer 2

CHD // HTN // VHD // hyperthyroidism

Question 3

don’t forget about … in DHx

Answer 3

caffeine

Question 4

Ix

Answer 4

ECG - trace of your heart’s electrical activity

bloods - FBC (anaemia), CRP (infection), U&E (++K), LFTs + coag (pre-warfarin), lipids, HBA1C

?echo // CXR

Question 5

Acute mx

Answer 5

1st line: rate control - bisoprolol // diltiazem

unsuccessful/haemo unstable: rhythm control w/ electrical cardioversion

Question 6

long-term mx

Answer 6

ongoing rhythm control - bisoprolol or left atrial ablation

Question 7

third aspect to consider when tx AF (other than rate v rhythm control)

Answer 7

coagulation risk - CHA2DS2-VASc score. if >2 –> warfarin/DOAC

ORBIT (HAS-BLED) - assess bleeding risk

Question 8

follow up

Answer 8

1 week - HR, BP & any symptoms // check tolerance & compliance to medication

Question 9

atrial flutter mx

Answer 9

Reduce alcohol
Avoid caffeine
Keep a diary of symptoms and any triggers
Careful safety netting
Review in 4 weeks, or sooner if symptoms are frequent/worsening