atrial fibrilation Flashcards
What is an arrhythmia
an abnormality in cardiac rhythm
what is atrial fibrillation
where the contraction of the atria is uncoordinated, rapid and irregular
why does AF occur
disorganised electrical activity that overrides the normal, organised activity from the sinoatrial node
What would an ecg show for AF
Absent P waves
irregular and rapid narrow QRS complex
presenting symptoms of AF could be …?
Palpitations
Shortness of breath
Syncope (dizziness or fainting)
Symptoms of associated conditions (e.g. stroke, sepsis or thyrotoxicosis
two differential diagnoses for an irregularly irregular pulse
-Atrial fibrilation
-ventricular ectopics
how would you differentiate AF and ventricular ectopic
ventricular ectopic disappear when the heart rate gets overa certain threshold
what is tachycardia
HR above 100beats per minute
two types of af and the difference
Valvular af = AF + mitral stenosis
Non - valvular = AF + without/ other valve pathology
two methods of treating AF
RATE CONTROL OR RHYTHM CONTROL
ANTI COAGULANTS
describe the acute management for AFib
- DC cardioversion or FLECANIDE /AMIODARONE if unsuccesful
- if >48hrs then give anticoagulation for three weeks before cardioversion or rate control , BB or CCB.
chronic management of Afib
rate control BB , rate limiting calcium channel blocker and if it fails add digoxin and then consider amiodarone
- if rhythm control is chosen make sure to give anticoagulation for a month
what is paroxsymal atrial fibrilation
when AF comes and goes in episodes
what are the two shockable rhymths
ventricualr tachycardia
ventricular fibrilation
two non shockable rhythms
pulseless electrical activity
asystole
What can cause atrial fibrilation
- mitral stenosis - fibrosis
- HF
-Sarcoidosis
what would deem a patient unstable
shock
hf
syncope
myocardial ischaemia
management for unstable patients
Emergency cardioversion
classification of afib
- first detected episode
- paroxsymal af
- persistent af
- permanent af
what can you do for rate control
beta blocker or rate limiting calcium channel blocker to control the rate
Rate control should be offered as the first‑line treatment strategy for atrial fibrillation except in people:
-atrial fibrillation has a reversible cause -heart failure thought to be primarily caused by atrial fibrillation
-with new‑onset atrial fibrillation (< 48 hours)
-with atrial flutter whose condition is considered suitable for an ablation strategy to restore sinus rhythm
f-or whom a rhythm‑control strategy would be more suitable based on clinical judgement
notable complications of afib
cardiac tamponade
stroke
pulmonary vein stenosis
