Atrial fibrillation Flashcards
Types of valvular AF
- mitral stenosis
- mechanical heart valve
Types of non-valvular AF
- AF without valve pathology
- mitral regurgitation
- aortic stenosis
What is paroxysmal AF
Episodic AF
Causes of AF (SMITH)
- sepsis
- mitral valve pathology
- ischaemic heart disease
- thyrotoxicosis
- hypertension
ECG AF
- absent P waves
- narrow QRS compelx tachycardia
- irregularly irregular ventricular rhythm
Differentiation between AF & V. Ectopic
If sinus rhythm during exercise —> v ectopic
HR aim & purpose of AF management
- <100bpm
- ++ time for v contraction
Do we start with rate or rhythm control for AF
Rate
Indications for rhythm control (contraindications for rate)
- reversible cause for AF
- AF of new onset - 48hrs
- AF causing HF
- symptomatic despite rate control
1st line of rate control
Beta blockers
Which rate control drugs should be avoided in HF
Calcium channel blockers
Which rate control drug that should be monitored for toxicity is only used in sedentary people
Digoxin
Purpose of rhythm control
Return to sinus rhythm
When should you start immediate cardioversion rhythm control rather than delayed
- AF <48hr
- HD instability
Pharmacological options for cardioversion rhythm control
- flecanide
- amiodarone
Electrical options for delivering cardioversion rhythm control
- sedation
- GA + defib
1st line long term medical rhythm control drug
Beta blockers
Long term medical rhythm control drug in HF/LVD
Amiodarone
Long term medical rhythm control drug that is contraindicated in metabolic imbalances due to its mechanism of blocking K, Na, Ca channels
Dronedarone
Why are anticoagulants used in delayed cardioversion
Clots formed in previous 48hrs
Which drug is used to treat paroxysmal AF that is contraindicated by A flutter
Flecanide
Is aspirin used in AF
No
Score that assesses if px w/ AF should take anticoagulants
CHA2DS2-VASc
CHA2DS2-VASc score implications
- 0 —> No
- 1 —> consider
- > 1 —> yes
Risk of bleeding in patient on anticoagulants score
HAS-BLED
CHA2DS2-VASc Stands for
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)
How often should apixaban + dabigatran be taken
Once daily
How often should rivaroxaban be taken
Twice daily
Reverse apixaban + rivaroxaban bleed
Andexanet
Reverse dabigatran bleed
Idarucizamab
V ectopic Tx
BBs/CCBs
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)
- 3 weeks
- 2.5
