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Cardiology > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

What ifs AF the most common form of?

A

Sustained cardiac arrhythmia

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2
Q

What is AF due to?

A

Uncoordinated, rapid and irregular contraction of the atria

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3
Q

What is the problem with the AV node in AF?

A

It responds intermittently leading to irregular ventricular contractions

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4
Q

How does AF typically present?

A

Palpitations
Dyspnoea
Chest pain
Syncope
Irregularly irregular pulse

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5
Q

How can AF be classified?

A

o Paroxysmal recurrent episodes
o Persistent recurrent episodes
o Permanent an ongoing

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6
Q

What is the classification of paroxysmal recurrent AF?

A

AF terminate spontaneously
Episodes last less than 7 days

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7
Q

What is the classification of Persistent recurrent episodes?

A

AF isn’t self-terminating
Episodes last greater than 7 days

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8
Q

What is the classification of Permanent and ongoing?

A

Continuous atrial fibrillation which cannot be cardioverted

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9
Q

How is AF diagnosed?

A

ECG

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10
Q

What ECG changes would you see in someone with AF?

A

Absent P waves
Narrow QRS Complex
Tachycardia
Irregularly irregular ventricular rhythm

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11
Q

What are the most common causes of AF?

A
  • Sepsis
  • Mitral Valve Pathology (stenosis or regurgitation)
  • Ischemic Heart Disease
  • Thyrotoxicosis
  • Hypertension
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12
Q

What can be used to remember the causes of AF?

A

Mrs SMITH

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13
Q

How fast does the atrial rhythm tend to be in someone with AF?

A

300-600bmp

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14
Q

What is the main risk in someone with AF?

A

Embolic stroke

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15
Q

What are the two key parts to managing someone with AF?

A

Rate control
Rhythm control

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16
Q

What medications are typically used for rate control in patients with AF?

A

Beta-blockers
Calcium channel blockers

17
Q

What betablocker is typically used for rate control in a patient with AF?

A

Bisoprolol

18
Q

What is a contraindication of betablockers?

A

Asthma and COPD
Hypotension (will lower BP further)

19
Q

What calcium channel blockers are typically used for rate control in a patient with AF?

A

Verapimil
Diltiazem

Not with BB

20
Q

What can be added to betablockers and CCBs if the rate is still not controlled?

A

Digoxin

21
Q

When should CCBs not typically be used?

A

In patients with heart failure

22
Q

Whom should digoxin only really be used for?

A

Sedentary people- risk of toxicity

23
Q

In which patients should rate control not be given first line?

A
  • 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.
24
Q

When should rhythm control be offered to patients?

A
  • 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
25
Q

How is rhythm control achieved?

A

A single cardioversion event

26
Q

What is the first line drug cardioversion in younger patients with no structural heart problems ?

A

Flecanide

27
Q

What is the first line drug cardioversion in older sedentary patients with structural heart problems?

A

Amiodarone

28
Q

What is used to determine the most appropriate anticoagulation strategy in someone presenting with AF?

A

CHA2DS2-VASc

29
Q

What does the CHA2DS2-VASc score stand for?

A

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)

30
Q

What does vascular disease include?

A

Ischaemic heart disease
Peripheral arterial disease

31
Q

Which anticoagulants are used in the management of AF with a CHA2DS2-VASc score of more than 2?

A

DOACs

32
Q

Which DOACs are used in the management of AF?

A

apixaban (main)
dabigatran
edoxaban
rivaroxaban

33
Q

What is the function of electrical cardioversion?

A

Rapidly shock the heart back into sinus rhythm

34
Q

What is the management of a patient presenting with acute AF (<48h) require treatment immediately e.g. very ill or haemodynamically unstable?

A

o Emergency DC cardioversion with sedation
—-IV amiodarone if cardioversion osn’t possible

35
Q

What is classified as fast AF?

A

Ventricular rate is >100bpm

36
Q

What is the management of AF with an onset of more than 48 hours?

A

DC cardioversion

37
Q

What must patients be treated with prior to DC cardioversion?

A

Anticoagulated for at least 3 weeks before

38
Q

Why do patients with AF require anticoagulation?

A

Due to risk of embolic stroke

39
Q

Which patients should be anticoagulated?

A

CHADS2-VASc score of
1 in men
2 in females

Cardiology (66 decks)

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