atrial fibrilation Flashcards
1
Q
Definition of AF
A
a supraventricular tachyarrhythmia with uncoordinated atrial electrical activation and consequently ineffective atrial contraction
2
Q
triggers for AF
A
PIRATES
- PE
- Ischemia
- Respiratory disease
- Atrial enlargement or myxoma
- Thyroid disease
- Ethanol
- sepsis/ sleep apnea
3
Q
symptoms of AF
A
- breathlessness
- palpitations
- chest discomfort
- syncope (fainting) or dizziness
- reduced exercise tolerance
- none (25-30%
4
Q
managing the AF patient
A
- stroke and thromboembolism prevention: anti-coagulation
- haemodynamics: rate and rhythm.
dont forget:
- concurrent trigger conditions (immediate)
- associated risk factor control (longer term)
5
Q
non-vitamin K antagonist oral anticoagulants (NOACs)
A
4 used in UK for stroke prevention:
- apixaban
- dabigatran etexilate
- edoxaban tosylate
- rivaroxaban
they selectively target specific receptors in the coagulation cascade:
- thrombin (dabigatran etexilate)
- factor Xa (apixaban, edoxaban tosylate and rivraoxaban)
6
Q
stroke and thromboembolism prevention
A
- assess risk of stroke: CHADs2VASC manage risks of bleeding: HASBLED - therapeutic options: --warfarin --NOACs
7
Q
rhythm control of AF
A
medication:
- beta-blockers, sotalol, flecainide, amiodarone
- DC cardioversion
- catheter ablation therapy using radio-frequency or cryoablation
- surgical MAZE procedure
8
Q
rate control of AF
A
heart rate slowing medication:
- beta-blockers (bisopropol, atenolol)
- non-dihydropyridine calcium channel antagonists (dilitazem)
- digoxin
9
Q
CHA2DS2-VASc
A
Congestive heart failure/ left ventricular dysfunction Hypertension Age >75yrs (2) Diabetes mellitus Stroke/transient ischaemic attack/TE (2) Age 65-74yrs Sex category (female)
10
Q
HASBLED
A
Hypertension Abnormal renal+ lever function (1/2) Stroke Bleeding Labile INR (<60%) Elderly (and>65yrs) Drugs/alcohol (1/2)
