AFib Flashcards
Types of AF
Paroxysmal
Persistent
Permanent
ECG findings
Absence of p waves
Fibrillatory waves in V1-3 or aVf
Irregularly irregular
170-180 bpm
Exam findings
No A wave in JVP
Auscultation - no S4
Causes
Pericarditis
PE or OSA
Ischemic heart disease or infarct
Rheumatic disease or other valvular pathology
Alcohol
Anemia
Thyrotoxicosis or toxins
Electrolytes
Sepsis
What are the signs of instability in a pt, and what is the management?
Altered mentation, hypotension, cardiac ischemia, angina, decompensated HF
Sedation + synchronised cardioversion with 200J
How to assess need for anticoagulation
CHAD65 score
> 65 y/o = use anticoagulation
< 65 y/o = any prior CHF, HTN, DM, Stroke or TIA = if yes, use anticoagulation
If none of these, check PAD or CAD = if yes, use antiplatelet like ASA or if already on ASA add clopidogrel
Take score, multiply by 2 = this is their yearly risk of stroke
CHADS2Vasc score points
CHF = 1
HTN = 1
Age >65 = 1, >75 = 2
DM = 2
Stroke/ TIA/ PE/ DVT = 2
Vas (MI, CAD, PAD) = 1
score to assess risk of bleeding from anticoagulation
HASBLED
When is warfarin 1st line?
valvular AF
Who needs rate control?
Symptomatic
Persistent AF should have HR <100
BB
Metoprolol IV 2.5-5mg now, repeat q15 mins x 2 until HR <100
HF - add digoxin as adjunct to BB
CAD - BB + CCB if further rate control needed
Sedentary - consider digoxin
Indications for rhythm control
Highly symptomatic - angina CP
Persistent AF impacting function
Multiple recurrences
If AF is causing cardiomyopathy
Method of cardioversion
If sx >24hrs, need to be anticoagulated x3 weeks before cardioverting
If <24hrs, can proceed immediately
If stable, use 100J
Risks of cardioversion
May not work
Sedation can cause apnea
If conversion works, might not cause relief of sx
Screening for AFib
check HR in all pts >65
How long to anticoagulant after cardioversion?
4 wks