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Y4 - Medicine - Cardiology > Arrhythmias - Atrial Fibrillation > Flashcards

Arrhythmias - Atrial Fibrillation Flashcards

1
Q

ESSENCE

A

Supraventricular tachyarrhythmia secondary to uncoordinated atrial contractions

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2
Q

What rhythm is caused

A

Irregularly irregular rhythm (non-repetative pattern in PR interval)

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3
Q

Cardiac consequences

A

Maybe reduced cardiac output and result in thrombus formation in atrium

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4
Q

What is most common site of origin for ectopic foci (abnormal pacemaker)

A

Pulmonary veins

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5
Q

PATHOGENESIS

A
  • Usually due to an underlying cause
    • eg atrial enlargement and inflammation or infiltrative disease affecting atrium
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6
Q

AETIOLOGY

5 most common causes

A
  • Remember AF affects mrs SMITH
    • Sepsis
    • Mitral valve pathology (stenosis or regurgitation)
    • Ischaemic heart disease
    • Thyrotoxicosis
    • Hypertension
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7
Q

EPIDEMIOLOGY

What is most common arrhythmia

A

Atrial fibrilation

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8
Q

CLINICAL FEATURES

Symptoms

A
  • Asymptomatic
  • In symptomatic cases
    • Palpitations
    • Shortness of breath (suggestive of heart failure)
    • Lightheadedness
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9
Q

CLINICAL FEATURES

Signs

A
  • Irregularly irregular pulse
  • Focal neurological deficit if results in embolic stroke
  • In cases where AF leads to HF
    • Elevated JVP
    • Bibasilar rates on pulmonary auscultation
    • Peripheral oedema
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10
Q

The 2 differentials for irregularly irregular pulse

A

AF

Ventricular ectopics

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11
Q

INVESTIGATIONS

First choice

A
  • ECG
    • If arrhythmia not captured then Holter monitoring in outpatient setting or telemitry in inpatient setting
  • Transthoracic echocardiogram (TTE)
  • Lab testing
    • TFT
    • U&Es
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12
Q

ECG findings

A
  • Absent P waves
  • Narrow QRS complex tachycardia
  • Irregularly irregular ventricular rhythm
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13
Q

DIFFERENTIALS

A
  • Multifocal atrial tachycardia
  • Premature atrial contractions
  • Atrial flutter
  • Wolff-Parkinson-White syndrome
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14
Q

MANAGEMENT

What does management depend on

A

Haemodynamically stable or not

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15
Q

MANAGEMENT

Haemodynamically unstable

A

Synchonised cardioversion

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16
Q

MANAGEMENT

General principles

A
  • Slowing on ventricular rate short term
  • Long term management
    • Rate and rhythm control
    • Anticoagulation to prevent stroke
17
Q

MANAGEMENT

When should patients not have rate control

A
  • Reversible cause for AF
  • AF new onset (within last 48 hours)
  • AF causing heart failure
  • remain symptomatic despite being effectively rate controlled
18
Q

MANAGEMENT

Options for rate control

A
  1. Beta-blocker
  2. CCB - not preferable in heart failure
  3. Digoxin - only in sedentary people, needs monitoring due to toxicity risk
19
Q

MANAGEMENT

Indications for rhythm control instead of rate control

A
  • Reversible cause of AF
  • New onset (<48 hours)
  • AF causing heart failure
  • Remain symptomatic despite being effectively rate controlled
20
Q

2 different kinds of cardioconversion

A
  • Immediate cardioconversion
    • AF been present <48 hours or severely haemodynamically unstable
  • Delayed cardioversion
    • AF present >48 hours and stable
21
Q

What should be done in delated cardioconversion in regards to medication

A

Should be anticoagulated for minimum of 3 weeks before cardioconversion

22
Q

2 options for cardioconversion

A

Pharmacological

Electrical

23
Q

First line for pharmacological cardioconversion

A
  • Flecanide
  • Amiodarone - drug of choice in patients with structural heart disease
24
Q

Lines for long term medical rhythm control

A
  1. Beta blockers
  2. Dronedarone
  3. Amiodarone - with heart failure or left ventricular dysfunction
25
Q

What does choice of anticoagulant depend on

A

CHA2DS2-VASc score

26
Q

Describe CHA2DS2-VAS2 score

A
  • CHA2DS2-VAS2
    • Congetive heart failure - 1 point
    • Hypertension - 1 point
    • Age =>75 - 2 points
    • Diabetes - 1 point
    • Stroke/TIA/Thromboembolism - 2 points
    • Vascular disease - 1 point
    • Age 65-74 - 1 point
    • Sex female - 1 point
27
Q
  • Coagulation choice for CHA2DS2-VASc score
    • 0 or 1
    • 2 or more
A
  • 0 or 1
    • Aspirin
    • Conservative monitoring
  • 2 or more
    • Dabigatran
    • Rivaroxaban
    • Apixaban
    • Warfarin
28
Q

What can reverse anticoagulation effects in uncontrolled/life-threatening bleeding

A
  • Andexanet alfa (apixaban and rivaroxaban)
  • Idarucizumab (monoclonal antibody against dabigatran)
29
Q

COMPLICATIONS

A
  • Atrial thombi emboli to cerebral vessels causing ischaemic stroke or TIA
  • Atrial thombus to common iliac artery
  • Renal infarction
30
Q

What tool is used to establish patients risk of major bleeding whilst on anticoagulation

A

HAS-BLED

31
Q

What is HAS-BLED score based on

A
  • HAS-BLED
    • Hypertension
    • Abnormal renal and liver function
    • Stroke
    • Bleeding
    • Labile INRs (whilst on warfarin)
    • Elderly
    • Drugs or alcohol

Y4 - Medicine - Cardiology (24 decks)

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