Atrial fibrillation Flashcards
What is atrial fibrillation a major risk factor of?
Stroke
What are the symptoms of atrial fibrillation?
- May be asymptomatic
- Palpitation
- Dyspnoea
- Rarely chest pain or syncope
- May present with complications e.g. stroke
How is atrial fibrillation diagnosed?
- Irregularly irregular pulse
* Confirmed by 12 lead ECG
What are the 3 categories of AF?
- Paroxysmal (intermittent, starts and stops)
- Persistent (more than 7 days)
- Permanent (more than a year)
What is the appearance of AF on ECG?
- variable rate
- Irregular, narrow QRS
- No p waves
What is the appearance of atrial flutter on ECG?
- Rate variable
- Regular narrow QRS
- Sawtooth atrial activity
What are the conditions that predispose to or encourage the progression of AF?
- Hypertension
- Symptomatic heart failure
- Valvular heart disease
- Cardiomyopathies
- Atrial septal defect and other congenital heart defects
- Coronary artery disease
- Thyroid dysfunciton
- obesity
- Diabetes
- COPD
- sleep apnoea
- Chronic renal disease
What are the objectives of AF treatment?
- Prevention of stroke
- Symptom relief
- Optimum management of concomitant cardiovascular disease
- Rate control
- ± correction of rhythm disturbance
What are the essential investigations for AF?
- ECG
- Echocardiogram
- Thyroid function tests (over active thyroid can cause AF)
- LFTs
What are the AF guidelines on rate control
- Aim for <110 bpm
- If still symptomatic aim for <80 bpm
- If no heart failure, start on a betablocker (bisoprolol) or rate limiting Ca2+ antagonist (verapamil)
- Digoxin is second line
What are the major risk factors for stroke in non-valvular AF?
- Previous stroke
- TSA or systemic embolism
- Age ≥75
What are the non major risk factors for stroke in non valvular AF?
- CHF
- Hypertension
- Diabetes
- 65-74 years old
- Female
- Vascular disease
What is the risk factor based points system for stoke in AF?
- CHA2DS-VASc
- Congestive heart failure/LV dysfunction - 1
- Hypertension -1
- Age ≥75 -2
- diabetes -1
- Stroke/TIA/thrombo-embolism -2
- Vascular disease - 1
- Age 65-74 -1
- Sex category - female -1
Describe stroke prevention using the CHA2DS2-VASc risk factors
- If 0 - no anticoagulant or antiplatelet treatment
- If 1 - OAC should be considered
- If ≥2 then NOAC or warfarin
Which patients with AF should be referred for OP specialist assessment?
- Patients stills symptomatic despite adequate rate control
- Young age <60
- Inadequate rate control despite Bet blocker or verapamil and digoxin
- Structural heart disease on echo
- Af and coexisting heart failure
What are the options for rhythm control?
- Direct current cardioverison
- Anti-arrhythmic drugs
- Catheter ablation
What are the types of anti-arrhythmic drugs?
- Class 1 = Na+ channel blockers
- Class 3 = K+ channel blockers, prolonging action potential duration (QRS)
- Multichannel blockers
Name 2 class 1 anti-arrhythmics
- Flecainide
* Propafenone
Name 2 class 3 anti arrhythmics
- Sotalol (beta blocker with additional class 3 activity)
* Amiodarone
Name a multichannel blocker
•Dronedarone
What is catheter ablation
- Identification of triggers of paroxysmal AF in the pulmonary veins
- Radiofrequency or cyro-ablation
What are the treatment options for long term rhythm control in patients with AF and no or minimal signs for structural heart disease?
Patient choice of:
•Drugs- dronedarone, flecaininde, propafenone or sotalol
•Catheter ablation
What are the treatment options for long term rhythm control in patients with AF and coronary artery disease, significant valvular heart disease, abnormal left ventricular hypertrophy?
Patient choice of:
•Dronedarone, sotalol or amiodarone
•Catheter ablation
What are the treatment options for long term rhythm control in patients with AF and heart failure?
- Amiodarone
* Catheter ablation
