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U16 Spine > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

Types of Arrhythmias

A
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2
Q

Classifications of Atrial fibrillations

A
  • Fist diagnosed - AF not diagnosed before, irrespective of its duration or the presence/severity of AF related symptoms
  • Paroxysmal - AF that terminates spontaneously or with intervention within 7days of onset.
  • Persistent - AF that is continuously sustained beyond 7 days, including episodes terminated by cardioversion (drugs or electrical cardioversion) after 7 or more days
  • Long-standing persistent - continuous AF of more than 12months duration when decided to adopt a rhythm control strategy
  • Permananent - af that is accepted by the patient + physician and not further attempts to restore/maintain sinus rhythm will be undertaken. Permannt AF represents a therapeutic attitidude of the patiwnet + physician rather than an inherent pathophysiologicla attribute of af, and term should not be used in context of rhythm contorl startegy with antiarrhythmic drug therapy or AF ablation. Should a rhythm contorl strategy be adopted, the arrhythmia would be re-classified as ‘long standing persistent AF’
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3
Q

causes of Atrial fibrillation

A
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4
Q

Normla sinus rhythm is

A

P wave spresent, regular and nromal morpholpgy (axis 0 to 75degrees)

QRS complexes are present, regular and narrow (<120ms)

1:1 ratio between p wave and QRS complex (HR 60-100bpm)

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5
Q

General Management of AF

for this case

A
  • ABCDE approach - clinical evaluation, investigations, treatmen. Airway patent (snoring, gurgling, responding to voice),Breathing spontaneously, Sa02, RR, chest sounds? ABG, CXR. Oxygen via non-rebreath mask. BP, HR, perfusion, HS? bloods, IV access, ECG, bedside echo.Fluids vs. furosemide, DCCV, drugs (atropine, adenosine, adrenaline) . GCS?, BM. expose the patient, abdomen SNT?
  • Invetsiagtions - ECG, CXR
  • Critical care review: I&V, DNACPR
  • Loaded on amiodarone 300mg IV and then 900mg IV over 24hours (via. CVC)
  • DC cardioversion
  • IV furosemide 40mg TDS
  • GTN infusion
  • Actrapid infusion
  • Norad started (low BP after intubation)

If unstable, patient requires imediate DC cardioversion.

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6
Q

Normal vs abnormal CXR

A

One on left, has consolidation (mos tlikely pulmonary oedema, has big heart, pleural effusion).

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7
Q
A

HR 150 irregular

No clear P waves

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8
Q

Advanced ;ife suppor tfor tachycardia

A
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9
Q

management for…

64-year old male admitted with palpitations and pre-syncope, started that very morning

PMH: Alcohol excess, previous TIA, recent positive COVID19 swab

DH: Nil regular

SH: Ex-smoker, good exercise tolerance

O/E, Sa02 98% on RA, RR 19, chest: mild bilateral wheeze, HR 128, BP 133/97, HS I + II + ESM, no pitting oedema

A

Do ECG - the image shows irregular tachycardia. Narrow complex - atrial fibrillaytion.

Manage with: (acute, <48hours onsey)

  • DC cardioversion - anaesthetic support fo rairway, can sat 50-100J and defibrillator but synchronised shock
  • IV amiodarone - 300mg iV loading dose then 900mg/24hours. Large bore cannula, ideally central line.

–

  • 2x failed DCCV. Loaded on amiodarone and given 24hour infusion via centrla line. Started on apizaban and bisoprosol
  • 24HOURS LATER- Stil in AF but rate controlled, discharged home wit outpatient Holter monitor, echo, elective DCCV. If onset <48hours, consider chemical or electrical cardioversion.
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10
Q

AF management

A

Anticoag, better symptoms ovntorl, CV risf factrord

  • DC cardioversion - anaesthetic support fo rairway, can sat 50-100J and defibrillator but synchronised shock
  • IV amiodarone - 300mg iV loading dose then 900mg/24hours. Large bore cannula, ideally central line.

if rhythm contorl fails then manage –

  • 2x failed DCCV. Loaded on amiodarone and given 24hour infusion via centrla line. Started on apizaban and bisoprosol
  • 24HOURS LATER- Stil in AF but rate controlled, discharged home wit outpatient Holter monitor, echo, elective DCCV.

If onset <48hours, consider chemical or electrical cardioversion.

Use score for anticoagulation.

Rate vs rhythm control

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11
Q

Management:

  • 70-year old M, admitted with 5/52 weeks worsening breathlessness and chest heaviness
  • PMH: COPD
  • DH: Nil regular
  • SH: smoker, good exercise tolerance, recently moved back from Spain
  • O/E, Sa02 97% on RA, RR 18, chest: intermittent wheeze + few crackle in L base, JVP +6, HR 132, BP 106/77, no pitting oedema
A
  • ECG - shows tachycardia, narrow complex (less than 3 swuares), irregular, no clear p waves, so atrial fibrillation (too irregular for atrial flutter).
  • Chest xR - fluid in lungs
  • Coudl do rhythmy startegy with fluconoaid, give
  • Anticoag
  • Give bsioprosl 5ml/od, xipca 5mg nlood. foresomide 40mgf ood. Echocrdiorghrapm, penign removed rate control.
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12
Q

Scoring anticog=ag risk

A
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13
Q

Treat AF. ABC pathway

A
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14
Q

SYmptom contol for AF

A
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15
Q

Rhtyhm control

A
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16
Q

Assess factord favouei rhyhtm control

17
Q

Anti-arrhythmic agents (AAD( dor atrioal firbillation )

A
  • Flecainide, propafenone
  • Amiodarone, dronedarone
18
Q

Rtae vs rhythm contor strat of AF

A

Rate vs. rhythm control

AFFIRM and RACE study: no difference

EAST AFNET study: benefits of early rhythm control

RACE II: lenient ~ strict rate-control

19
Q
A

Compehensive AF risk fators for optimising outome of AF catheter addtion.

20
Q

80-year old F with 24 hours history of intermittent pre-syncope + palpitations

PMH: Admission 1 year ago with normal echocardiogram and normal coronary angiogram, hypothyroidism

DH: bisoprolol 1.25mg od (very symptomatic at higher doses), atorvastatin 20mg at night

SH: good exercise tolerance, independent

O/E, Sa02 95% on RA, RR 18, chest: clear, JVP normal, HR 150, BP 115/90, no pitting oedema

A

ECG looks liek atrial fluter. Treatment startegues ar ethe smae.

  • Flecamide 200mg ov e RN when symptomd cccour amd are not settling. Flecanaide s contradictae n those with exisr ibtanche s or cnry hert fidease
  • Pill in pocket srat is option for heslth pstient wihi interefrequent episode od syptomatic AF
    *
21
Q

Overall treatment for AF

A

üAF is a very heterogeneous condition with various different treatment strategies (often, there is more than one way to treat the presentation)

ü

General approach to treating arrhythmias:

  1. If haemodynamically unstable, proceed directly to DC cardioversion
  2. Treat reversible causes (e.g. infection, fluid depletion, electrolytes)
  3. Does the patient need acute (intravenous) treatment or is a gentler oral treatment safer and equally effective?

●

üIn AF, remember A (anticoagulation), B (better symptom control), C (cardiovascular risk factors)

U16 Spine (12 decks)

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