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Week 5 - Cardiology > Atrial fibrillation > Flashcards

Atrial fibrillation Flashcards

1
Q

What is atrial fibrillation a major risk factor of?

A

Stroke

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2
Q

What are the symptoms of atrial fibrillation?

A
  • May be asymptomatic
  • Palpitation
  • Dyspnoea
  • Rarely chest pain or syncope
  • May present with complications e.g. stroke
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3
Q

How is atrial fibrillation diagnosed?

A
  • Irregularly irregular pulse

* Confirmed by 12 lead ECG

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4
Q

What are the 3 categories of AF?

A
  • Paroxysmal (intermittent, starts and stops)
  • Persistent (more than 7 days)
  • Permanent (more than a year)
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5
Q

What is the appearance of AF on ECG?

A
  • variable rate
  • Irregular, narrow QRS
  • No p waves
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6
Q

What is the appearance of atrial flutter on ECG?

A
  • Rate variable
  • Regular narrow QRS
  • Sawtooth atrial activity
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7
Q

What are the conditions that predispose to or encourage the progression of AF?

A
  • 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
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8
Q

What are the objectives of AF treatment?

A
  • Prevention of stroke
  • Symptom relief
  • Optimum management of concomitant cardiovascular disease
  • Rate control
  • ± correction of rhythm disturbance
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9
Q

What are the essential investigations for AF?

A
  • ECG
  • Echocardiogram
  • Thyroid function tests (over active thyroid can cause AF)
  • LFTs
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10
Q

What are the AF guidelines on rate control

A
  • 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
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11
Q

What are the major risk factors for stroke in non-valvular AF?

A
  • Previous stroke
  • TSA or systemic embolism
  • Age ≥75
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12
Q

What are the non major risk factors for stroke in non valvular AF?

A
  • CHF
  • Hypertension
  • Diabetes
  • 65-74 years old
  • Female
  • Vascular disease
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13
Q

What is the risk factor based points system for stoke in AF?

A
  • 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
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14
Q

Describe stroke prevention using the CHA2DS2-VASc risk factors

A
  • If 0 - no anticoagulant or antiplatelet treatment
  • If 1 - OAC should be considered
  • If ≥2 then NOAC or warfarin
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15
Q

Which patients with AF should be referred for OP specialist assessment?

A
  • 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
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16
Q

What are the options for rhythm control?

A
  • Direct current cardioverison
  • Anti-arrhythmic drugs
  • Catheter ablation
17
Q

What are the types of anti-arrhythmic drugs?

A
  • Class 1 = Na+ channel blockers
  • Class 3 = K+ channel blockers, prolonging action potential duration (QRS)
  • Multichannel blockers
18
Q

Name 2 class 1 anti-arrhythmics

A
  • Flecainide

* Propafenone

19
Q

Name 2 class 3 anti arrhythmics

A
  • Sotalol (beta blocker with additional class 3 activity)

* Amiodarone

20
Q

Name a multichannel blocker

A

•Dronedarone

21
Q

What is catheter ablation

A
  • Identification of triggers of paroxysmal AF in the pulmonary veins
  • Radiofrequency or cyro-ablation
22
Q

What are the treatment options for long term rhythm control in patients with AF and no or minimal signs for structural heart disease?

A

Patient choice of:
•Drugs- dronedarone, flecaininde, propafenone or sotalol
•Catheter ablation

23
Q

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?

A

Patient choice of:
•Dronedarone, sotalol or amiodarone
•Catheter ablation

24
Q

What are the treatment options for long term rhythm control in patients with AF and heart failure?

A
  • Amiodarone

* Catheter ablation

Week 5 - Cardiology (8 decks)

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