Arrhythmia - Atrial Fibrillation and Flutter

Question 1

How does AF occur?

Answer 1

When impulses that should come from SA only fire off from different places in atria in a disorganised way

Question 2

How does AF show on an ECG?

Answer 2

Irregular and fast pulse
Can be palapted

Lots of waves in between QRS complexes

Question 3

Acute AF treatment?

Answer 3

Emergency cardioversion:
DC shock
IV amiodarone

Control ventricular rate:
1st line= B.blocker - bisoprolol
CCBs - verapamil/diltiazem

2nd line= Digoxin or amiodarone

Place on anticoagulants:
Heparin until full risk assessment is done
Warfarin if risk of emboli is high

Question 4

Chronic AF treatment goals?

Answer 4

Rate control
Rhythm Control
Anticoagulants

Question 5

Rate control plan for chronic AF?

Answer 5

Need to get below 90bpm

1st line - CCBS/BBs

Digoxin if BBs and CCBS fail

Question 6

Rhythm control plan for chronic AF?

Answer 6

If risk of cardioversion treatment failing - pre treat with Amiodarone for 4 weeks

If no structural heart disease - Flecanide

If structural heart disease - Amiodarone

Anticoagulants - Warfarin or Aspirin if warfarin is contraindicated

Question 7

What is atrial flutter?

Answer 7

Emanates from a small group of ectopics or a single ectopic focus

Electrical impulses are more regular than A-fib

The AV node still conducts - but only every 3rd or 4th impulse

Question 8

Atrial flutter treatment?

Answer 8

Vagus manouvers such as carotid sinus massage

IV adenosine