Arrhythmias 1 : Atrial fibrillation Flashcards
1) What is an Ectopic beat?
2) What are the treatment options?
1) Irregular heart rhythm due to a premature heartbeat
2) If beats are spontaneous and patient has normal heart rate, treatment rarely required- reassure patient
↳ If troublesome give B-blockers
What should all patients at risk of atrial fibrillation (AF) be assessed for? (2)
1) Risk of stroke
2) Risk of thromboembolism
List the two ways AF be managed?
1) Ventricular rate control
2) Restoring sinus rhythm (rhythm control)
↳if treatment fails at any stage or symptoms reappear referral should be made within 4 weeks
What should be reviewed annually in all AF patients? (3)
1) Anticoagulation
2) Stroke
3) Bleeding risk
What is the treatment option for patients presenting with life-threatening haemodynamic instability caused by new onset AF
Emergency electrical cardioversion to achieve anticoagulation
What is the treatment option for patients presenting with acute AF without life threatening haemodynamic instability if the:
1) onset of arrhythmia is ˂ 48h
2) onset of arrhythmia is ˃48h
1) Rate or rhythm control can be offered if onset ˂ 48h
2) Rate preferred if onset ˃48h or uncertain
1) What is cardioversion?
2) when should electrical cardioversion be used rather than pharmacological cardioversion?
1) Medical procedure by which an abnormally fast heart rate or other cardiac arrhythmia is converted to a normal rhythm using electricity or drugs (rhythm control)
2) If AF that has persisted for > 48 hours, electrical cardioversion is used
Which drugs are used to treat an acute presentation of AF if pharmacological cardioversion is used?
IV amiodarone or alternatively flecainide acetate. ↳Amiodarone preferred if there is structural heart disease
2) if urgent rate control required IV B-blocker or Verapamil
1) If AF has been present for more than 48h what type of cardioversion is preferred?
2) Cardioversion should not be attempted until the patient has been anti-coagulated for how many weeks?
1) Electrical cardioversion preferred
2) Do not attempt unless patient has been anti-coagulated for at least 3 weeeks.
3) parenteral anticoagulation should be commenced, and a left atrial thrombus ruled out immediately before cardioversion
Cardioversion should not be attempted until the patient has been anti-coagulated for at least 3 weeks. What if this is not possible?
parenteral anticoagulation should be commenced, and a left atrial thrombus ruled out immediately before cardioversion
Oral anticoagulation should be given after cardioversion and continued for how many weeks?
At least 4 weeks
↳(prior to cardioversion, offer rate control)
Rate control is the preferred first-line drug treatment strategy for atrial fibrillation, except in which patients ?
1) New-onset AF
2) Atrial flutter suitable for an ablation strategy
3) AF with a reversible cause
↳Refer to a cardiologist for consideration of rhythm-control treatment (cardioversion)
Rate control is the preferred first-line drug treatment strategy for most people with atrial fibrillation. Outline the drugs are used to control ventricular rate?
1) Standard B-blocker (not sotalol) or rate limiting CCB such as diltiazem or verapimil as monotherapy
2) Digoxin only effective for controlling the ventricular rate at rest, so only used as monotherapy in predominantly sedentary patients with non-paroxysmal atrial fibrillation.
A B-blocker or a rate-limiting CCB are both first line rate control options in AF. With regards to the patient, what does the choice between these two drugs depend on?
1) Co-morbidities
↳ B-blockers : C/I in asthma
↳Rate-limiting CCBs are C/I in people with co-existing heart failure
1) What drugs can be given if a single agent fails to control ventricular rate?
2) what if this is still not adequate?
1) A combination of 2 drugs including a B-blocker, digoxin or diltiazem can be used.
2) If symptoms still not controlled with 2 drugs a rhythm-control strategy should be considered
If ventricular function is diminished, the combination of which two drugs is preferred in AF?
Beta-blocker (that is licensed for use in heart failure) and digoxin is preferred.
which drug should be used if atrial fibrillation is accompanied by congestive heart failure?
Digoxin
what is paroxysmal atrial fibrillation?
Paroxysmal AF occurs when a rapid, erratic heart rate begins suddenly and then stops on its own within 7 days. (non-paroxysmal AF is relatively established arrhythmia longstanding-persistent)
Which drugs can be used to maintain sinus rhythm post-cardioversion, If drug treatment is required?
1) Standard B-blockers can be used to control rhythm.
2) If above is not suitable oral sotalol, flecainide, propafenone or amiodarone.
↳Flecainide or propafenone C/I in ischaemic or structural heart disease.
Which drug can be started up to 4 weeks before and continued for up to 12 months after electrical cardioversion to increase success of the procedure?
Amiodarone to increase success of the procedure, and to maintain sinus rhythm.
1) In symptomatic paroxysmal atrial fibrillation, which drug can be used to control ventricular rhythm?
2) what if symptoms persist or the above is C/I?
1) B-blockers
2) Dronedarone, sotalol hydrochloride, flecainide , propafenoneor amiodarone hydrochloride can be given
The “pill in the pocket” approach can be used to control infrequent episodes of symptomatic paroxysmal AF. Outline this method, stating the drugs used
patient takes drug to self treat episode of AF when it occurs.
↳ flecainide or profaferone is used to restore sinus rhythm
Name the two asssessmet tools recommended by NICE toassess a patients stroke and bleeding risk in AF?
1) CHA2VASc for stroke risk
2) HAS-BLED for bleeding risk pror to anticoagulation
List the risk factors taken into account by CHA2DS2-VAS and state what risk score for males and females is associated with low risk of stroke (6)
1) Prior ischemic stroke, TIA or thromboembolic event
2) Heart failure, vascular disease, left ventricular systolic disfunction
3) Diabetes
4) Hypertension
5) Females
6) Over 65 years
↳Score of 0 in men and 1 for women, is associated with low risk and do not require antithrombotic for stroke prevention
