Atrial Fibrilation

Question 1

What are common symptoms of Afib?

Answer 1

Sweating and palpitations (absent A waves)

These symptoms indicate irregular heart rhythms.

Question 2

List some common causes of Afib.

Answer 2

• PE
• COPD
• Pneumonia
• Hypertension
• Heart failure
• Mitral stenosis

These conditions can lead to the development of Afib.

Question 3

What is the most common cause of Afib, represented by the acronym SMITH?

Answer 3

• Sepsis
• Mitral valve issues
• Ischemic heart disease (IHD)
• Thyrotoxicosis
• Hypertension

This acronym helps remember the main causes of Afib.

Question 4

Describe the ECG characteristics of Afib.

Answer 4

Irregular ventricular rate with no P waves

This indicates a disorganized electrical activity in the heart.

Question 5

What is the main goal of treating Afib?

Answer 5

Alleviate symptoms, reduce the risk of stroke, and treat underlying causes

Effective management of Afib focuses on symptom relief and prevention of complications.

Question 6

What should be done for a patient with Afib who is haemodynamically stable for less than 48 hours?

Answer 6

DC Cardioversion, Rate or Rhythm control

This approach is taken to restore normal rhythm or control heart rate.

Question 7

What is the recommended treatment for Afib if the patient has been in Afib for more than 48 hours?

Answer 7

Anticoagulation for 3 weeks prior to cardioversion followed by rate control

This is to prevent thromboembolic events during cardioversion.

Question 8

What is the first-line treatment for rate control in Afib?

Answer 8

• Beta-Blockers
• Calcium Channel Blockers (CCB)
• Digoxin

These medications help manage heart rate effectively.

Question 9

What medications can be used for rhythm control in Afib?

Answer 9

• Flecainide
• Amiodarone (for structural defects)
• Dronedarone (after cardioversion)

These are antiarrhythmic drugs used to restore normal rhythm.

Question 10

What is catheter ablation in the context of Afib?

Answer 10

Ablation of faulty electric pathways between the pulmonary vein and left atrium

This procedure is aimed at correcting the electrical signals that cause Afib.

Question 11

What is the approach for anticoagulation in patients with Afib?

Answer 11

4 weeks before and during procedures, based on CHA2DS2-VASC score

This score assesses stroke risk to determine the need for anticoagulation.

Question 12

What should be done for a patient with Afib who is haemodynamically unstable?

Answer 12

Cardioversion

Immediate cardioversion is required to stabilize the patient.

Question 13

True or False: Patients under 65 years old with no comorbidities should use DOACs for Afib.

Answer 13

False

Patients in this category do not require direct oral anticoagulants (DOACs).

Question 14

When should DOACs be used in patients with Afib?

Answer 14

Patients aged 65 and older with at least one comorbidity

This group is at a higher risk for stroke and may benefit from anticoagulation.

Question 15

What is a characteristic feature of Aflutter?

Answer 15

Regular ventricular rhythm, sawtooth pattern

This pattern is often referred to as ‘F-waves’ on an ECG.

Question 16

What can happen to patients with Aflutter after treatment?

Answer 16

They can develop Afib

This highlights the potential progression of atrial arrhythmias.

Question 17

What is the Valsalva manoeuvre?

Answer 17

Increased pressure within the chest cavity that triggers slowing of the heart

This technique can be used as a vagal maneuver to manage certain arrhythmias.

Question 18

What is the best treatment for Aflutter?

Answer 18

Catheter ablation

This is often the most effective method to eliminate the arrhythmia.