AF & Hypertension Flashcards by Luse Mwenechanya

What type of AF is more common in younger patients?

Paroxysmal

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How would you describe AF to a patient?

AF is an abnormally fast and irregular heart rhythm meaning that you heart cannot fill with blood as effectively and can’t pump blood as effectively around your body
Symptoms include palpitations, dizziness, shortness of breath & tiredness

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What is the average atrial rhythm in AF and average ventricular rhythm?

Atrial: 300-600 bpm
Ventricular: 160-180

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What are the most common causes of AF?

Ischaemic heart disease/ heart failure 
MI
Htn 
Valvular heart disease
Hyperthyroid

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What are some less common causes of AF?

Caffeine/ alcohol 
PE
pneumonia 
post-op 
Hypokalaemia/ hypomagnaesia

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What is paroxysmal AF?

Episodes lasting >30 seconds but less than 7 days
Self limiting & recurrent
More common in younger

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What is persistent AF?

2 or more episodes
Require medical/DC cardioversion to resolve
Return

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What is permanent AF?

AF not resolved with cardioversion
AF that relapses within 24 hours
Controlled by rate limiting drugs

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What are the complications of AF?

Stroke/TIA - thromboembolic risks or anticoagulant risk due to warfarin
Heart failure

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How would AF be described on an ECG?

Irregularly irregular narrow complex tachycardia

Absent P waves

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What investigations are carried out if suspected AF?

24 hour ambulatory ECG

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What would be seen on an ECHO in AF?

(Left) atrial enlargement

mitral valve disease

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What is CHADS2VASC score used to determine?

What are the components?

Assess stroke risk
C - congestive HF = 1
H - hypertension - 1
A - age ≥75 = 2
D - diabetes = 1
S2 - stroke/TIA/ thromboembolism = 2
V - vascular disease = 1
A - age 65-74 = 1
S - sex female = 1

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What is the recommendation of a Female with a chads2vasc score of 1?

No action - she is scoring for sex

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What is the recommendation of a male with a chads2vasc score of 1?

Consider starting anticoagulation

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What is the recommendation of a Female with a chads2vasc score of 2?

Offer anticoagulation

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What anticoagulation is recommended for AF?

Warfarin

NOAC

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What is the risk of a person with AF developing a stroke compared to someone in normal sinus rhythm?

5x higher

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What tool is used to assess someone’s bleeding risk with anticoagulant?

HAS BLED

H - hypertension = 1
A - abnormal renal/liver function = 1 or 2
S - stroke = 1

B - bleeding = 1
L - labile INRs = 1
E - elderly >65 = 1
D - drugs/alcohol = 1 or 2

What is the normal starting dose of warfarin?

5-10mg

What is the target INR for those with AF?

2-3

Who should warfarin be avoided in?

Pregnancy - teratogen
Peptic ulcer
Bleeding disorders
p450 metabolising drugs

What is the mechanism of action of warfarin?

Vitamin K antagonist

What is the mechanism of action of NOACs?

Inhibit free factor Xa

What is the dose of NOACs?

20mg OD with food

What is first line for rate control in AF? | When is this contraindicated?

B-blocker - metaprolol Use rate limiting CCB if asthmatic - verapamil/diltiazem If not controlled then combine b blocker & diltiazem or digoxin DO NOT COMBINE B-BLOCKER AND VERAPAMIL = COMPLETE HEART BLOCK

When is digoxin used in rate control of AF?

Not as effective as CCB or B-blocker Used in HF

What is used to maintain sinus rhythm in those with known AF?

Sotalol Amiodarone Flecainide

If a haemodynamically stable patient presents with AF 12 hours after onset what is the treatment?

Pharmacological cardioversion - flecainide or amiodarone

What is the treatment for all new onset AF?

LMWH - tinzaparin until assessment is made

What is classified as hypertension?

BP > 140/90

What is classified as malignant hypertension?

>200/120

What should BP aim be for those age ≥80?

150/90

Further testing should not be conducted and treatment started right away if the BP is what?

>180/90

Ambulatory BPM takes the average of at least how many BP readings throughout the day?

ABPM of what indicates need for treatment?

``` <80 = 135/85 >80 = 145/85 ```

What is used to assess cardiovascular risk? What does it calculate? How often should this be repeated?

QRISK2 % risk of MI or stroke in next 10 years Repeat every 5 years

What other investigations should be done when suspecting htn?

U&Es - inc. createnine Glucose - DM or obese eGFR

For someone with stage 1 htn, medication is started when the QRISK2 score is?

>20%

What is 2nd line management of htn if 1st line is not adequate?

ACE-i + CCB OR ARB

What is 3rd line management of htn?

ACE-i + CCB + Thiazide (ACD)

What is 4th line management of htn?

``` Add alpha-blocker OR Add another diuretic - low dose k+ sparing or high dose thiazide OR Beta-blocker ```

ARB should be preferred over ACE-i in which group of people?

Afro-carribean

Why should you try not to combine ACE-i with ARB or B-blocker with diuretic?

can aggravate diabetes

What is 2nd line treatment of htn in afro-carribeans?

CCB + ARB ARB preferred over ACE-i