Atrial fibrillation

Question 1

Types of valvular AF

Answer 1

• mitral stenosis

- mechanical heart valve

Question 2

Types of non-valvular AF

Answer 2

• AF without valve pathology
• mitral regurgitation
• aortic stenosis

Question 3

What is paroxysmal AF

Answer 3

Episodic AF

Question 4

Causes of AF (SMITH)

Answer 4

• sepsis
• mitral valve pathology
• ischaemic heart disease
• thyrotoxicosis
• hypertension

Question 5

ECG AF

Answer 5

• absent P waves
• narrow QRS compelx tachycardia
• irregularly irregular ventricular rhythm

Question 6

Differentiation between AF & V. Ectopic

Answer 6

If sinus rhythm during exercise —> v ectopic

Question 7

HR aim & purpose of AF management

Answer 7

• <100bpm

- ++ time for v contraction

Question 8

Do we start with rate or rhythm control for AF

Answer 8

Rate

Question 9

Indications for rhythm control (contraindications for rate)

Answer 9

• reversible cause for AF
• AF of new onset - 48hrs
• AF causing HF
• symptomatic despite rate control

Question 10

1st line of rate control

Answer 10

Beta blockers

Question 11

Which rate control drugs should be avoided in HF

Answer 11

Calcium channel blockers

Question 12

Which rate control drug that should be monitored for toxicity is only used in sedentary people

Answer 12

Digoxin

Question 13

Purpose of rhythm control

Answer 13

Return to sinus rhythm

Question 14

When should you start immediate cardioversion rhythm control rather than delayed

Answer 14

• AF <48hr

- HD instability

Question 15

Pharmacological options for cardioversion rhythm control

Answer 15

• flecanide

- amiodarone

Question 16

Electrical options for delivering cardioversion rhythm control

Answer 16

• sedation

- GA + defib

Question 17

1st line long term medical rhythm control drug

Answer 17

Beta blockers

Question 18

Long term medical rhythm control drug in HF/LVD

Answer 18

Amiodarone

Question 19

Long term medical rhythm control drug that is contraindicated in metabolic imbalances due to its mechanism of blocking K, Na, Ca channels

Answer 19

Dronedarone

Question 20

Why are anticoagulants used in delayed cardioversion

Answer 20

Clots formed in previous 48hrs

Question 21

Which drug is used to treat paroxysmal AF that is contraindicated by A flutter

Answer 21

Flecanide

Question 22

Is aspirin used in AF

Answer 22

No

Question 23

Score that assesses if px w/ AF should take anticoagulants

Answer 23

CHA2DS2-VASc

Question 24

CHA2DS2-VASc score implications

Answer 24

• 0 —> No
• 1 —> consider
• > 1 —> yes

Question 25

Risk of bleeding in patient on anticoagulants score

Answer 25

HAS-BLED

Question 26

CHA2DS2-VASc Stands for

Answer 26

``` C – Congestive heart failure H – Hypertension A2 – Age >75 (Scores 2) D – Diabetes S2 – Stroke or TIA previously (Scores 2) V – Vascular disease A – Age 65-74 S – Sex (female) ```

Question 27

How often should apixaban + dabigatran be taken

Answer 27

Once daily

Question 28

How often should rivaroxaban be taken

Answer 28

Twice daily

Question 29

Reverse apixaban + rivaroxaban bleed

Answer 29

Andexanet

Question 30

Reverse dabigatran bleed

Answer 30

Idarucizamab

Question 31

V ectopic Tx

Answer 31

BBs/CCBs

Question 32

If long term rhythm control is considered in AF>48hrs warfarin should be given for how long before rhythm control starts (and what INR are we aiming for)

Answer 32

- 3 weeks | - 2.5