Atrial Fibrillation Flashcards
What is atrial fibrillation?
Irregular and often fast heart rate
Causes of AF?
Cardiac problems: CAD MI Heart valve problems Hypertension
What is paroxysmal AF?
AF that begins and stops on its own within 7 days
What is persistent AF?
AF that persists for more than 7 days or that has required cardioversion for termination of the rhythm
What is permanent AF?
AF that is present all the time
AF on an ECG?
No visible P waves and an irregularly irregular QRS complex
Management of patient in AF who is haemodynamically unstable
DC cardioversion
Management of patient in AF and haemodynamically stable?
Check anticoagulation status
If already on anticoagulants - immediate/delayed cardioversion
If not on anticoagulants - initiate anticoagulation
Management of haemodynamically stable patients with symptomatic AF of >48 hours?
Rate control e.g. beta-blockers
Management of haemodynamically stable patients with symptomatic AF of <48 hours
Early cardioversion
3 forms on management in AF?
Rate-control
Rhythm control
Anticoagulation
Symptoms of AF?
Asymptomatic
Palpitations
Shortness of breath
Signs of AF?
Irregularly irregular pulse
Absent ‘a’ wave on JVP: corresponds to atrial contraction
Tachycardia
Rate-control drugs?
Beta-blockers (e.g. metoprolol, bisoprolol)
Rate-limiting calcium channel blockers (e.g. verapamil, diltiazem)
Digoxin: usually reserved for patients that do no or very little physical exercise (e.g. bedbound) or other drugs are inappropriate (contraindicated, side-effects, patient preference).
Rhythm control (cardioverting) drugs?
Pharmacological: amiodarone, flecainide, beta-blockers (e.g. sotalol).
Electrical: DC cardioversion
Patients who may be suitable for rhythm control?
New-onset AF Identifiable reversible cause Heart failure(exacerbated by AF) Associated with atrial flutter(and ablation strategy appropriate) Rhythm control felt more suitable
Purpose of anti-coagulation in patient with AF?
Patients with AF are at increased risk of thromboembolic events due to stasis of blood and formation of clots, predominantly in the left atrial appendage
How to assess stroke risk in patients with AF?
CHA2DS2-VASc
How to assess stroke risk in patients with AF?
CHA2DS2-VASc score - anyone who scores 2 or more gets a DOAC
This is balanced with
ORBIT score - this measures bleeding risk and has replaced HAS-BLED
