afrial fibrillation Flashcards
what is AF
Uncoordinated, rapid and irregular contraction of the atria due to disorganised electrical activity which overrides the normal activity from the SAN.
AF on ecg
Absence of P waves
Narrow QRS complex tachycardia
Irregularly irregular ventricular rhythm
loss of a wave on JVP form so single wave
rise in JVP durin inspiration known as kussumal sing is pathological of what
constrictive pericarditis
cannon a waves sign of what
compelte heart blcok
large a waves sign of what
pulmoary hypetension or stenosis
large v waves
triscupid regurgitation
MRS smith cuases
Sepsis
Mitral valve pathology
Ischaemic heart disease
Thyrotoxicosis
HTN
sx
Palpitations
SoB
Syncope
Symptoms of associated conditions (e.g. stroke, sepsis or thyrotoxicosis)
tx should involve Assess haemodynamic stability (shock/syncope/chest pain/pulmonary oedema)
if
Unstable ⇒ Immediate DC cardioversion
Rate/Rhythm Control + Anticoagulation (stroke prevention) is stable
AF <48 hrs ⇒ Rhythm control
AF >48 hrs ⇒
Rate control
tx should involve Assess haemodynamic stability (shock/syncope/chest pain/pulmonary oedema)
if
Unstable ⇒ Immediate DC cardioversion
Rate/Rhythm Control + Anticoagulation (stroke prevention) is stable
AF <48 hrs ⇒ Rhythm control
AF >48 hrs ⇒
Rate control
rate control over 48hr what is used
beta blocker - atenolol - dont use in COPD and astha or in hypotension
or CCB but dont use this in hear failure
line 2 is digonxin - aovid yoner patietns
when can you not use CCB
heart failure
when can you not use BB
asthma or COPD
ryhtm control comes before 48hrs what do you do
electricla cardioversion and a DOAC
flecainide - yougner patients
amiodarone - older
CHADS-VAS score of what means offer anticoauglation
A and S 2
2 or more
what does chadsvas stnad for
congestive heart faulure
HTN
age over 75
diabetes
stroke or TIA
vasucalr disease
age 65-74
sex- female
what tool can you use to assess someone at risk of major bleeding whilst on anticoagualnt
HAS BLED
HTN
abnromal renal and liver fucntion, stroke, blleding , labile INR, elderly , alcohol or drugs
what is the ORBIT score
The ORBIT score predicts bleeding risk in patients who are taking anticoagulants for atrial fibrillation.
sex , HB under 130 males nad 120 females
age over 74, bledding hstproy , renal fucntion under 60
concormitatn use of antiplatelets
paroxysmal AF
comes and goes in epsidoes lasting under 48hours - shoudl be anticoagualted based on score
Tx for paroxysmal AF
flecainide
what can flexainide cause
torsades de pointes
if has bled score over 3 what
no anti coagulatn treatmetn offered
apical to radial pulse deficit
yes
when should BB be stopped
in heart fialure or heart block
