Afib Flashcards
What are two ways afib can occur? (2 marks)
stimulus from a site other than the SA node or the stimulus spreading across the heart in an abnormal pathway
What is afib also known as? (1 mark)
Cardiac dysrhythmias
What is afib? (3 marks)
quiver/squirm
300 + per min
no effective contraction
Describe three types of afib? (6 marks)
paroxysmal afib- self terminating episodes for 48 hours
valvular afib- afib in pts with moderate or severe mitral stenosis or a mechanical heart valve
non-valvular afib- afib in pts without moderate or severe mitral stenosis or a mechanical heart valve
Why might patients not know they have afib? (1 mark)
Afib is usually asymptomatic
What are some symptoms of afib? (4 marks)
tiredness, breathlessness, dizziness and palpitations
What are the two types of haemostasis related complications of afib and what is the difference? (4 marks)
thrombus- clot which forms in the vessel and stays there
embolus- clot which forms in the vessel and moves
How can AF lead to ischaemic stroke or TIA? (2 marks)
clots form in the atria as the atria doesn’t contract
they become emboli and are pumped out of the heart blocking brain vessels
what are the two broad treatment options for afib and what do they do? (4 marks)
- rhythm control- reverses HR to sinus rhythm
- rate control- slows conduction rate of the AV node and increases refractory period of the AV node
List three ways you can treat afib with rhythm control (3 marks)
cardioversion, catheter ablation and antiarrhythmic therapy
What is the mechanism of action of digoxin? (2 marks)
reduces AV conduction and increases contraction force
What is digoxin’s effect on hospitalisation and mortality? (2 marks)
reduces hospitalisations but no effect on mortality
Would digoxin be used for rhythm or rate control? (1 mark)
Rate control
What does CHADS stand for? (5 marks)
Congestive heart failure hx
Hypertension
Aged 75+
Diabetes mellitus
Stroke or TIA hx
What are two drugs you could use to prevent risk of stroke for patients with Afib? (2
Warfarin and NOACs (apixaban, rivaroxaban and dabigatran)
Should you use aspirin or P2Y12 inhibitors such as clopidogrel to prevent thromboembolic events in a patient with afib? (1 mark)
No
What is the difference between CHADS2 and CHA2DS2-VA? (2 marks)
CHA2DS2-VA further stratifies low-risk people with non-valvular AF
When should a patient nor be switched from warfarin? (3 marks)
They cannot maintain an INR of 2-3 for 60-70% of the time due to poor adherence
What are three scenarios where you should consider switching a patient from Warfarin? (3 marks)
Pt cannot undergo routine INR monitoring
They cannot tolerate warfarin
Patient preference
How do you switch from warfarin to a NOAC? (3 marks)
stop warfarin, start NOAC when INR reaches below 2
How do you switch from a NOAC to warfarin? (3 marks)
Start Warfarin, continue NOAC until INR is under 2
What are five factors to consider when choosing a NOAC for a patient? (5 marks)
age, bleeding risk, effect of food, compliance aid, renal function, half-life, comorbidities, antidotes available, drug interactions, dosing frequency and compliance
Whatis AFib and what complications can it lead to? 7 marks
AFib is a cardiac dysrhythmia (1) which is fast (1), disorganised electrical activity in the atria (1). The atria quivers and squirms 300 times a minute. (1) It can lead to clots forming in the atria (1) and an ischaemic stroke (1) or TIA (1)
What are 2 rationales for AFib treatment?
o Reduce symptoms and minimise morbidity by slowing ventricular rate and maintain sinus rhythm
o Prevent stroke
o Treatment can focus on rhythm control or rate control
What is the drug class of digoxin?
cardiac glycoside
what are 3 adverse effects of digoxin
nausea, vomiting, diarrhoea, bradycardia, arrhythmia
what is the MOA of digoxin?
increases the refractory period of the AV node and slows conduction
what should you not put with a beta blocker in afib?
verapamil
What are two adverse effects of beta blockers?
bradycardia and reduced cardiac output
what is the drug class of Diltiazem and verapamil? What is one side effect?
non-dihydropine ccbs. Bradycardia
What is an adverse effect of a beta blocker?
bradycardia
What should you monitor for when using amiodarone? 3 marks
Monitor BP, check liver function and electrolytes before starting
What are 3 side effects of amiodarone?
nausea and vomiting, constipation
what are 3 side effects of Flecainide?
nausea, vomiting , diarrhoea
what do you monitor when using flecainide?
drug concentration
what are two side effects of Sotalol?
palpitations and hypotension
what do you need to monitor when using sotalol?
Monitor QT interval with dose increases
Name 4 drugs/drug classes for rate control
Digoxin, BBs, Diltizam and verapamil
Name 3 drugs/drug classes for rhythm control
Amiodarone, flecainide and soltalol
What is the MOA of digoxin?
Slows heart rate, reduces atrioventricular (AV) nodal conduction, increases vagal tone, reduces sympathetic activity and increases the force of myocardial contraction
What is the MOA of non dihydropyridine CCBs?
act on cardiac and arteriolar smooth muscle. They reduce cardiac contractility, heart rate and conduction
