Atrail fibrillation/flutter Flashcards
Risk stratify risk of stroke in a patient with non-valvular AF
CHA2DS2-VASc score - indications of 1 yr risk of TE even in non-anticoagulated pt with non-valvular AF
Congestive Heart failure Hx = 1
Hypertension Hx = 1
Age 65-74yr = 1 >75 = 2
Diabetes = 1
Stroke/TIA/Thromboembolism Hx = 2
Vascular disease Hx (prior MI, perferal vascular disease, aortic plaque = 1
A
Sex Male = 0 Female = 1
Score 0 - low risk - may not require anticoagulation
Score 1 -low-moderate risk - consider anti platelet or anticoagulation
Score 2 or more than -moderate to high risk- anticoagulation
Causes of AF
Pulmonary disease - COPD, PE
Ischemia - ACS
Rheumatic heart disease - mitral stenosis
Anaemia - High output failure/tachycardia//atrial myxoma
Thryotoxicosis
EthanoL/endocarditis
Sepsis/sick sinus syndrome
Cx of AF
Reduced cardia output = dyspnoea & lethargy = HF Palpitations Ischaemia Heart pain and Syncope Thrombus - stroke
RF that make Cx of AF more likely
Age
Coincident heart disease
Instability of the rhythm: conversion between AF and sinus rhythm may dislodge Atrial thrombus.
Mx of AF
Goal to control ventricle rate and prevent Thromboembolism
Rate control - Digoxin (in elderly) or B blockers or Ca antagonist eg diltiazem or verapamil. Can use combination.
Rhythm control - Cardioversion after ruling out clots and covering with anticoagulates. Amiodarone or flecainide can be used
Calicum gluconate?
If paroxysmal prevention -cardioversion
Surgical - ablation, internal Atrial defibrillators
Class of arrhythmia drugs
Class 1 - fast sodium channel blockers - MOA varies. 1A - Quinidine, procainamide, disopyramide
Class 2 beta blockers MOA - decrease slope of phase 4 = longer between beats
Class 3 - potassium channel blockers - prolongs phase 3 - some have more
Class 4 - Slow calcium channel blockers - prolongs phase 2
Class 5 - variable mechanism eg adenosine, Digoxin, magnesium sulfate.
Types of AF
Parosynsmal AF = 24 - 48 hr = cardioversion
Persisitent AF =days to weeks
Permanent or chronic AF
Types of anticoagulants
Warfarin - inhibit Vit K reductase. Competition inhibitation
Heparin
LMWH - eg clexane (enoxaparin, dalteparin
Direct thrombin inhibtor and NOC
- Lepirudin or bialirubin inhibit thrombin directly
- Dabigatran - direct thrombin inhibitor
- Rivaroxaban - inhibit factor Xa
Causes of AF
Pulmonary disease - COPD, PE
Ischemia - ACS
Rheumatic heart disease - mitral stenosis
Anaemia - High output failure/tachycardia//atrial myxoma
Thryotoxicosis
EthanoL/endocarditis
Sepsis/sick sinus syndrome
Cx of AF
Reduced cardia output = dyspnoea & lethargy = HF Palpitations Ischaemia Heart pain and Syncope Thrombus - stroke
RF that make Cx of AF more likely
Age
Coincident heart disease
Instability of the rhythm: conversion between AF and sinus rhythm may dislodge Atrial thrombus.
Mx of AF
Goal to control ventricle rate and prevent Thromboembolism
Rate control - Digoxin (in elderly) or B blockers or Ca antagonist eg diltiazem or verapamil. Can use combination.
Rhythm control - Cardioversion after ruling out clots and covering with anticoagulates. Amiodarone or flecainide can be used
Calicum gluconate?
If paroxysmal prevention -cardioversion
Surgical - ablation, internal Atrial defibrillators
Class of arrhythmia drugs
Class 1 - fast sodium channel blockers - MOA varies. 1A - Quinidine, procainamide, disopyramide
Class 2 beta blockers MOA - decrease slope of phase 4 = longer between beats
Class 3 - potassium channel blockers - prolongs phase 3 - some have more
Class 4 - Slow calcium channel blockers - prolongs phase 2
Class 5 - variable mechanism eg adenosine, Digoxin, magnesium sulfate.
Types of AF
Parosynsmal AF = 24 - 48 hr = cardioversion
Persisitent AF =days to weeks
Permanent or chronic AF
Types of anticoagulants
Warfarin - inhibit Vit K reductase. Competition inhibitation
Heparin
LMWH - eg clexane (enoxaparin, dalteparin
Direct thrombin inhibtor and NOC
- Lepirudin or bialirubin inhibit thrombin directly
- Dabigatran - direct thrombin inhibitor
- Rivaroxaban - inhibit factor Xa
