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Cardio > Atrial Fibrilation > Flashcards

Atrial Fibrilation Flashcards

1
Q

what is atrial fibrillation?

A

when the electrical activity of the atria becomes disorganised
causes fibrillation (random muscle twitching) of the atria
leads to an irregularly irregular pulse

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2
Q

what are the overall effects of atrial fibrillation?

A

irregularly irregular ventricular contractions
tachycardia
heart failure - due to impaired filling of ventricles during diastole
increased risk of stroke

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3
Q

what does the sinoatrial node normally do?

A

produces organised electrical activity that coordinates the contraction of the atria

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4
Q

what happens to the electricity in the heart in atrial fibrillation?

A

it becomes disorganised
the chaotic electricity overrides the normal electricity from the sinoatrial node

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5
Q

what does the disorganised electricity in the heart lead?

A

uncoordinated, rapid, irregular atrial contractions

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6
Q

what happens when the disorganised electricity overrides the normal electricity from the SA node?

A

the disorganised electricity passes to the ventricles
causing irregularly irregular ventricular contractions

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7
Q

what can uncoordinated atrial contractions cause blood to do?

A

stagnate in the atria
forming thrombus (blood clot)

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8
Q

what can a thrombus in the left atrium cause?

A

ischaemia stroke
if the blood clot travels to the brain and blocks a cerebral artery

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9
Q

what is the risk of stroke associated with atrial fibrillation?

A

patients with AF are at a 5x higher risk than usual

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10
Q

what are the causes of atrial fibrillation?

A

Sepsis
Mitral valve pathology
Ischaemic heart disease
Thyrotoxicosis
Hypertension

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11
Q

what are lifestyle causes of AF?

A

alcohol
caffeine

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12
Q

what are patients with AF often?

A

asymptomatic

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13
Q

when is AF commonly found?

A

accidentally
may be diagnosed after a stroke

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14
Q

how may patients with AF present?

A

palpitations
shortness of breath
dizziness/syncope
symptoms of associated conditions - stroke, sepsis, thyrotoxicosis

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15
Q

what is a key exam finding?

A

irregularly irregular pulse

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16
Q

what does an irregularly irregular pulse mean?

A

the patient has either atrial fibrillation or ventricular ectopics

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17
Q

what suggests a diagnosis of ventricular ectopics and why?

A

a normal heart whilst exercising
ventricular ectopics disappears once the heart rate is above a certain threshold

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18
Q

what do all patients with an irregularly irregular pulse require?

A

ECG

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19
Q

what are the ECG findings for atrial fibrillation?

A

absent P waves
narrow QRS complex tachycardia
irregularly irregular ventricular rhythm

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20
Q

what may an echocardiogram be used for in atrial fibrillation?

A

further investigations of:
valvular heart disease
heart failure
planned cardioversion

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21
Q

what is paroxysmal atrial fibrillation?

A

reoccurring episodes of atrial fibrillation that spontaneously go back to normal sinus rhytm

22
Q

how long can episodes of paroxysmal atrial fibrillation last?

A

between 30s and 48hrs

23
Q

what are patients with suspected paroxysmal atrial fibrillation and a normal ECG given for further investigation?

A

24hr ambulatory ECG
cardiac event recorder listing 1-2 weeks

24
Q

what is valvular atrial fibrillation?

A

atrial fibrillation with significant mitral stenosis or a mechanical heart valve
the assumption is that the valve pathology has left to AF

25
Q

what is non-valvular AF?

A

AF with no valvular pathology or other valvular pathology - i.e. mitral regurgitation or aortic stenosis

26
Q

what are the principles of management for atrial fibrillation?

A

rate or rhythm control
anticoagulation - prevent strokes

27
Q

how do the ventricles fill with blood when the atrial contractions are uncoordinated?

A

gravity and suction - much less effective
increased heart rate = less time for the ventricles to fill = decreased cardiac output

28
Q

what are the aims or rate control?

A

to get the heart rate below 100bpm and extend the time of diastole for the ventricles to fill

29
Q

who is rate control not first line for when managing atrial fibrillation?

A

reversible causes of AF
new onset AF - within the last 48hrs
HF caused by AF
symptoms despite effectively rate controlled

30
Q

what medications are used for rate control?

A

beta blockers are first line - atenolol or bisoprolol
calcium channel blockers - dilimiazem or verapamil but should be avoided in those with HF
digoxin - only for sedentary people with persistent AF, needs monitoring and there is a risk of toxicity

31
Q

when is rhythm control used?

A

when rate control is not :
reversible causes of AF
new onset AF - within last 48hrs
HF caused by AF
symptomatic despite being effectively rate controlled

32
Q

what are the aims of rhythm control?

A

to return the heart to normal sinus rhythm

33
Q

what are the two methods of rhythm control?

A

cardioversion
long-term rhythm control - medication

34
Q

what are the two types of cardio version?

A

immediate
delayed

35
Q

when is immediate cardoversion used?

A

when atrial fibrillation:
has been present for less than 48hrs
is causing life-threatening haemodynamic instability

36
Q

what are the two methods of immediate cardio version?

A

pharmocological
electrical

37
Q

what drugs can be used for pharmacological cardio version?

A

flecanide
amiodarone - useful for patient with structural heart disease

38
Q

what is the aim of electrical cardio version?

A

to shock the heart back into sinus rhythm

39
Q

how is electrical cardioversion done?

A

with a cardiac defibrillator machine that delivers a controlled shock
this is usually done under sedation or general anaesthetic

40
Q

when is delayed cardioversion used?

A

when atrial fibrillation;
has been present for more than 48hrs and the patient is stable

41
Q

what type of cardioversion is recommended for delayed cardioversion?

A

electrical
transoesophageal echocardiography-guided cardioversion is also an option when available

42
Q

what medication may be considered before and after a delayed cardioversion and why?

A

amiodarone
to prevent atrial fibrillation from recurring

43
Q

what should a patient be for at least 3 weeks before a cardioversion and why?

A

anticoagulated
within 48hrs before they may develop a thrombus
reverting to sinus rhythm has a high risk of mobilising the clot and causing a stroke

44
Q

how are patients awaiting delayed cardioversion managed?

A

rate control

45
Q

what medications can be used for long-term rhythm control?

A

beta blockers are first line
dronedarone is second line for maintaining sinus rhythm after a successful cardioversion
amiodarone is useful for patients with heart failure or left ventricular dysfunction

46
Q

what may patients with paroxysmal atrial fibrillation be suitable for?

A

pill in the pocket

47
Q

what is pill in the pocket?

A

where patients take a pill to terminate their AF but only when they feel symptoms

48
Q

what is required for pill in the pocket?

A

infrequent episodes
no structural heart disease
identify signs of AF
understand when to take pill

49
Q

what drug is usually used for pill in the pocket?

A

flecanide
should still be anti coagulated if qualify

50
Q

what is the risk of flecanide in AF?

A

risk of converting atrial fibrillation into atrial flutter with 1:1 conduction to the ventricles = very fast ventricular rate

Cardio (4 decks)

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