Atrial Fibrillation Flashcards
What ifs AF the most common form of?
Sustained cardiac arrhythmia
What is AF due to?
Uncoordinated, rapid and irregular contraction of the atria
What is the problem with the AV node in AF?
It responds intermittently leading to irregular ventricular contractions
How does AF typically present?
Palpitations
Dyspnoea
Chest pain
Syncope
Irregularly irregular pulse
How can AF be classified?
o Paroxysmal recurrent episodes
o Persistent recurrent episodes
o Permanent an ongoing
What is the classification of paroxysmal recurrent AF?
AF terminate spontaneously
Episodes last less than 7 days
What is the classification of Persistent recurrent episodes?
AF isn’t self-terminating
Episodes last greater than 7 days
What is the classification of Permanent and ongoing?
Continuous atrial fibrillation which cannot be cardioverted
How is AF diagnosed?
ECG
What ECG changes would you see in someone with AF?
Absent P waves
Narrow QRS Complex
Tachycardia
Irregularly irregular ventricular rhythm
What are the most common causes of AF?
- Sepsis
- Mitral Valve Pathology (stenosis or regurgitation)
- Ischemic Heart Disease
- Thyrotoxicosis
- Hypertension
What can be used to remember the causes of AF?
Mrs SMITH
How fast does the atrial rhythm tend to be in someone with AF?
300-600bmp
What is the main risk in someone with AF?
Embolic stroke
What are the two key parts to managing someone with AF?
Rate control
Rhythm control
What medications are typically used for rate control in patients with AF?
Beta-blockers
Calcium channel blockers
What betablocker is typically used for rate control in a patient with AF?
Bisoprolol
What is a contraindication of betablockers?
Asthma and COPD
Hypotension (will lower BP further)
What calcium channel blockers are typically used for rate control in a patient with AF?
Verapimil
Diltiazem
Not with BB
What can be added to betablockers and CCBs if the rate is still not controlled?
Digoxin
When should CCBs not typically be used?
In patients with heart failure
Whom should digoxin only really be used for?
Sedentary people- risk of toxicity
In which patients should rate control not be given first line?
- There is reversible cause for their AF
- Their AF is of new onset (within the last 48 hours)
- Their AF is causing heart failure
- For whom a rhythm control strategy would be more suitable based on clinical judgement.
When should rhythm control be offered to patients?
- There is a reversible cause for their AF
- Their AF is of new onset (<48 hours)
- Their AF is causing heart failure
- They remain symptomatic despite being effectively rate controlled
How is rhythm control achieved?
A single cardioversion event
What is the first line drug cardioversion in younger patients with no structural heart problems ?
Flecanide
What is the first line drug cardioversion in older sedentary patients with structural heart problems?
Amiodarone
What is used to determine the most appropriate anticoagulation strategy in someone presenting with AF?
CHA2DS2-VASc
What does the CHA2DS2-VASc score stand for?
C Congestive heart failure
H Hypertension (or treated hypertension)
A2 Age >= 75 years
Age 65-74 years
D Diabetes
S2 Prior Stroke, TIA or thromboembolism
V Vascular disease
S Sex (female)
What does vascular disease include?
Ischaemic heart disease
Peripheral arterial disease
Which anticoagulants are used in the management of AF with a CHA2DS2-VASc score of more than 2?
DOACs
Which DOACs are used in the management of AF?
apixaban (main)
dabigatran
edoxaban
rivaroxaban
What is the function of electrical cardioversion?
Rapidly shock the heart back into sinus rhythm
What is the management of a patient presenting with acute AF (<48h) require treatment immediately e.g. very ill or haemodynamically unstable?
o Emergency DC cardioversion with sedation
—-IV amiodarone if cardioversion osn’t possible
What is classified as fast AF?
Ventricular rate is >100bpm
What is the management of AF with an onset of more than 48 hours?
DC cardioversion
What must patients be treated with prior to DC cardioversion?
Anticoagulated for at least 3 weeks before
Why do patients with AF require anticoagulation?
Due to risk of embolic stroke
Which patients should be anticoagulated?
CHADS2-VASc score of
1 in men
2 in females
