Atrial Fibrilation

Question 1

Symptoms of AF

Answer 1

Palpitations, dyspnoea, chest pain

Question 2

Signs of AF

Answer 2

Irregularly irregular pulse

Question 3

First line treatment of AF

Answer 3

Beta blocker or rate-limiting calcium channel blocker

Question 4

Second line treatment of AF

Answer 4

Combination of two of the following: betablocker, diltiazem or digoxin

Question 5

When is rhythm controlled stratergy recommended for patients with AF

Answer 5

Coexistent heart failure, first onset AF, or where there is an obvious reversible cause

Question 6

What situations can cardioversion be used

Answer 6

Emergency in haemodynamically unstable patients, or when rhythm control stratergy is preferred for that patient.

Question 7

What is the treatment option for cardioversion if onset is within 48 hours

Answer 7

Heparinised patients, then given DC cardioversion, or pharmacological interventions

Question 8

Pharmacology rhythm control options for patients with structural heart disease

Answer 8

Amiodarone

Question 9

Pharmacological optinos for rhytm control in AF patients

Answer 9

Amiodarone or fleccainide

Question 10

What is the treatment option for cardioversion if onset is after 48 hours

Answer 10

Anticoagulation given 3 weeks prior, or exclude left atrial appendage by TOE. Then electrical cardioversion is recommended

Question 11

Management of haemodynamically stable patients if onset <48 hours

Answer 11

Rate or rhythm control

Question 12

Management of haemodynamically stable patients if onset >48 hours

Answer 12

Rate control, if considered for long term rhythm control delay cardioversion until maintained on therapeutic anticoagulation for 3 weeks

Question 13

Management of haemidynamically unstable patients

Answer 13

Electrical cardioversion