Atrial Fibrillation Flashcards
what is AF
failure for the atria to conduct and push blood into the ventricles
causes
ischaemic heart disease
hypertension
rheumatic heart disease
infection
signs
dizziness
syncope
palpitations
irregularly irregular pulse
investigations
ECG
management
rate control:
bisoprolol
CCB
digoxin
rhythm control:
cardioversion - pharmacological or electrical
if presented with 48hrs of symptoms:
immediate cardioversion + heparin
if presented after 48hrs of symptoms:
3 weeks till cardioversion but anti-coagulant therapy must be given
anti-coagulation therapy:
DOAC
warfarin
LMWH
why is anti-coagulation therapy given
to reduce risk of stroke
what scores are used for giving anti-coagulation therapy
C - congestive failure H - hypertension A2 - >75 yrs D - diabetes S2 - previous stroke V - vascular disease A - 65-74 S - female sex
ORBIT is used to assess bleeding risk
what is paroxysmal AF
symptoms of AF but reside normally
management of paroxysmal AF
flecainide
when is a beta blocker contradicted
asthma
hypotension
what should be given with cardioversion
low molecular weight heparin
when is direct current cardioversion indicated
haemodynamically unstable
what is a benefit of digoxin
preserves ejection fraction
what is seen on the ECG for AF
absence of P waves and
irregular narrow complex tachycardia
what is the criteria for starting anti-coagulant therapy
CHA2DS2VAS scoring:
0 - nothing
1 - male consider, females no
2 or more - yes
what is the exception for starting anti-coagulant therapy with a CHA2DS2VAS score
valvular problems
what are the types
paroxysmal - resolves normally
persistent - continuous > 7 dats
permanent - >12 months and considering rhythm control
what factors do you ignore that can contribute to bleeding risk
age and fall
what medications are involved in pharmacological cardioversion
amiadorone
flueicanide
how long do you continue anticoagulants for
high risk of stroke:
lifelong
low risk of stroke:
4 week post cardioversion
