Atrial fibrillation Flashcards
What are the triggers for AF?
heart failure, HTN, IHD, PE, mitral valve disease, pneumonia, hyperthyroidism, caffeine, alcohol, hypokalaemia, hypomagnesaemia
Which is the main complication of AF?
embolic stroke
What are the components of the CHA2DS2-VASc score?
Congestive Cardiac Failure Hypertension Age >74(2 points) Diabetes Previous Stroke/TIA (2 points) Vascular disease Age 65-74 (1 point) Female sex (1 point).
Which scoring system is employed to calculate risk of bleeding versus risk of embolic stroke?
HAS-BLED
What are the components of the HAS-BLED score?
Labile INR Age >65 Use of medications predisposing to bleeding Alcohol abuse Uncontrolled hypertension History or predisposition to major bleeding Renal disease Liver disease Stroke history.
What is the management of AF with low CHADVASC score and no heart failure present?
- Establish rate control
- Heparin
- Electrical or pharmacology cardioversion once heparin is established
What is the management of AF with high CHADVASC score and no heart failure present?
- Establish rate control
- Anticoagulation
- Electrical or pharmacology cardioversion following 3-4 weeks of anticoagulation
Rate 88/min - Regular rhythm - Axis -20o - PR duration 0.26 secs (constant) - QRS complex 0.08 seconds - QT interval 0.2 seconds. You note that p waves are only present before each QRS and that the rhythm is regular. What is the best summary of this patient's ECG?
First degree heart block
In this case there is fixed delay (through the AV node) which is first degree heart block. The PR interval should be <0.2 seconds.
It is always good practice to compare a current ECG to a previous ECG but this should not prevent you reviewing and summarising the ECG.
You have been asked to see a 26 year old male in clinic who previously attended A+E via ambulance after suffering a syncopal episode whilst walking home from work. He made a spontaneous recovery and was discharged. A resting ECG was performed which showed ST-elevation in leads V1-V3. He denies any chest pain and cardiac enzymes were not raised. Echo is normal. He tells you two of his relatives died sudden in their 20s.
What is the most likely diagnosis?
Brugada syndrome t is caused by a mutation in the cardiac sodium channel gene, known as a sodium channelopathy. A diagnosis can only be made with the characteristic Brugada ECG patterns (coved ST segment elevation in >1 of V1-V3 followed by a negative t wave) and one of the following criteria: - documented VF - polymorphic VT - family history of sudden cardiac death <45 yrs old - coved type ECGs in family members - syncope - nocturnal agonal respiration
List three common causes of AF
IHD
HTN
Rheumatic heart disease
Thyrotoxicosis
Other: Alcohol PE Hypokalaemia RA Pneumonia
Where does blood pool in AF?
left atrial appendage
Approaches to AF management?
Cardioversion Catheter ablation- Maze procedure Pacing + AV node ablation Antiarrhythmic drug control Stroke prevention
What are the components of the CHA2DS2VAS score?
CHA 2 -DS 2 CCF HTN Age≥75 (2 points) DM Stroke or TIA (2 points) VAS Vascular disease Age: 65-74yrs Sex: female
When should anticoagulation be considered in AF? What are the options for anticoagulation?
CHADVASC score >1 in men and >2 in women.
Oral anticoagulant, DOAC e.g. dibgatran or warfarin
When would you opt for warfarin over DOAC?
prosthetic valves, antiphospholipid syndrome, or a high risk of gastrointestinal bleeding
