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Cardio > AFib > Flashcards

AFib Flashcards

1
Q

pathophysiology?

A
  • atrial ectopic beats (automaticity foci) thought to originate in pul veins –> lead to uncontrolled contraction of atria & irregular, fast, fibrillatory activity (300-600bpm) which also leads to irregular contraction of ventricles
  • due to the irregular contractions, atria fail to empty adequately & blood pools there–> risk of clot formation
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2
Q

symptoms?

A
  • often asymptomatic
  • dizziness
  • palpitations
  • SOB
  • collapse
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3
Q

signs?

A
  • irregularly irregular pulse
  • pulse deficit
    • fast AF–> loss of diastolic filling –> no detectable pulse
  • signs of LVF
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4
Q

DDx for irregularly irregular pulse?

A
  • AF
  • Ventricular ectopics

can be differentiated w ECG

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5
Q

what are ventricular ectopics & how do they present?

A
  • premature ventricular beats caused by random electrical discharges from outside atria
  • presents as random, brief palpitations
  • disappear when HR gets over a certain threshold
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6
Q

aetiology of ventricular ectopics

A
  • common at all ages and in healthy patients
  • more common if pre-existing heart condition
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7
Q

diagnosis of ventricular ectopics?

A

individual random, broad QRS complexes on the background of a normal ECG

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8
Q

Ix & findings on ECG?

A
  • Bloods
  • ECG
    • no P waves
    • narrow QRS
    • irregularly irregular ventricular rhythm
    • undulating baseline
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9
Q

classification of AF

A
  • valvular
    • moderate/severe MS too
  • non-valvular
    • any other valvular pathology or none at all
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10
Q

aetiology? mnemonic

A

MRS SMITH

Sepsis

Mitral valve pathology

IHD

Thyrotoxicosis

Hypertension

also…

  • Lung disease- PE/Pneumonia
  • Alcohol
  • ASD
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11
Q

complications?

A
  • risk of stroke
    • clot embolise to brain–> ischaemic stroke
  • HF due to poor filling of ventricles
  • sudden death
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12
Q

types of AF?

A
  • paroxysmal
  • persistent
  • permanent
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13
Q

what is paroxysmal AF

A
  • recurrent episodes
  • terminates spontaneously within 7 days
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14
Q

what is persistent AF?

A

lasts >7 days, requires termination by pharamcological or electrical cardioversion (may still recur after this)

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15
Q

what is permanent AF?

A
  • refractory to cardioversion
  • sinus rhythm cannot be restored or maintained
  • AF is accepted as final rhythm
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16
Q

main principles of Rx

A
  • rate /rhythm control
  • anticoagulation
17
Q

Mx of paroxysmal AF

A

Rx: pill in pocket (flecainide) + anticoagulation

prevention: beta blocker/amiodarone/sotalol

18
Q

Mx of acute AF (<48h)

A
  • haemodynamically unstable
    • emergency electrical cardioversion
  • no haemodynamic instability
    • Rate control (or rhythm control)
      • aim is <100bpm
    • if no spontaneous conversion to sinus rhythm:
      • start LMWH
      • immediate cardioversion (electrical or pharmacological)
19
Q

Mx of persistent AF?

A
  1. rate control, unless
    • reversible cause for AF
    • AF is of new onset
    • AF is causing HF
    • they remain symptomatic despite being effectively rate controlled

if any of above circumstances, offer rhythm control

20
Q

options for rate control?

A
  1. beta blockers- metoprolol
  2. rate limiting CCB - Verapamil
    • not preferable in HF
  3. Digoxin
    • only in non-paroxysmal AF & if sedentary
21
Q

options for rhythm control?

A
  • cardioversion
    • immediate vs delayed
    • elctrical vs pharmacological
  • long-term medical rhythm control
22
Q

other options, when drug treatment has failed?

A
  • radiofrequency ablation of AV node
  • maze procedure
  • cardiac pacing
23
Q

what should be given 4 weeks before electrical cardioversion & up to 12 months after?

A

amiodarone therapy

24
Q

if AF>48h, what is preferred route of cardioversion?

A

electrical

25
Q

by how much does anti-coagulation reduce risk of stroke in AF?

A

by 2/3

26
Q

tool for assessing whether patient with AF needs to be started on anti-coagulation?

A

C- Congestive HF

Hypertension

A2- Age>75 ( score=2)

Diabetes

S2-Stroke or TIA previously (score=2)

Vascular disease

Age 65-74

Sex (female)

27
Q

who does NICE recommend should start anti-coagulation?

A

in ALL pts with score 2 or more

  • to be considered in men score >1
  • women with a score of 1 due to gender = not an indication for treatment
28
Q

assessment tool for assessing someone’s risk of bleeding whilst on anti-coagulation?

A

HT

Abnormal liver /renal function

Stroke

Bleeding

Labile INRs

Elderly

Drugs /alcohol

29
Q

what anti-coagulants are given in AF?

A
  • warfarin
  • NOAC

if above contra-indicated: dual anti-platelet therapy

30
Q

what anti-coagulants are given post stroke?

A

warfarin or direct thrombin/factor Xa inhibitor

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