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exams - cardio (megan) > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

What is atrial fibrillation?

A

A heart condition that causes a very fast heart rate. Caused by uncoordinated contractions of the atrium by disorganised electrical activity which overrides the SA nodes.

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2
Q

What are the 3 ECG changes seen with AF?

A

Absent P waves
Narrow QRS waves with tachycardia
Irregularly irregular ventricular rhythm.

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3
Q

How does AF present?

A 
Often asymptomatic and picked up coincidentally. 
Palpitations
dyspnoea
fatigue
dizziness
weakness
syncope
chest pain
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4
Q

What is the pulse like in AF?

A

irregularly irregular.

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5
Q

which conditions cause an irregularly irregular pulse?

A

Atrial fibrilaltion
Ventricular ectopics
Sinus arrhythmia

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6
Q

What points the diagnosis towards ventricular ectopics and not AF?

A

The heart rate is normal on exercise (because in ventricular ectopics, over a certain heart rate the heart goes back to normal). AF has an abnormal heart rate and rhythm regardless.

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7
Q

what are the common causes of AF? SMITH

A 
sepsis
mitral valve pathology (regurgitation or stenosis)
ischaemic heart disease 
thyrotoxicosis
hypertension
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8
Q

What causes valvular AF?

A

Having a mechanical heart valve or mitral stenosis.

Other valve diseases are not though to cause AF.

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9
Q

What is the management for AF?

A

Rate control
Rhythm control
Anticoagulation

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10
Q

What is the rate control management for AF?

A

1st line - beta blocker (bisoprolol or atenolol)

2nd line - calcium channel blocker (diltiazem)

3rd line - digoxin

If one doesn’t work, use two medications together.

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11
Q

When can calcium channel blockers not be used?

A

NOT to be used in heart failure

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12
Q

When is digoxin used most commonly?

A

In sedentary people

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13
Q

Why does digoxin need to be monitored?

A

because theres a risk of toxicity.

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14
Q

Why is rate control important?

A

To get the HR below 100, to allow a longer period of time for the heart to be in diastolic to allow the ventricles to fill more leading to an increased cardiac output.

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15
Q

What is the treatment for rhythm control?

A

1st line - beta blocker (bisoprolol or atenolol)

2nd line - dronedarone

3rd line - amiodarone

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16
Q

When is dronedarone used>

A

when patients have had successful cardio version, used to maintain this rhythm.

17
Q

When is amiodarone used?

A

Good for patients with heart failure

18
Q

What is converting to a normal rhythm called?

A

Cardioversion - either electrical or medical.

19
Q

What is the treatment for electrical cardioversion?

A

anaesthetic then defibrillator

20
Q

What should be done. before attempting cardio version?

A

Should only be done if the patient has had AF for <48hrs.

OR

If patient has had AF for >48hrs - they should be on anticoagulation prior to cardio version attempt.

21
Q

When are patients at highest risk of a stroke?

A

when they are converting between AF rhythm to a normal sinus rhythm.

22
Q

What anticoagulation is given as treatment?

A

NOT ASPIRIN

Warfarin
OR

DOACS/NOACS:
Apixaban
dabigatran
rivaroxaban

23
Q

What is the medical cardio version treatment?

A

Amiodarone

flecanide

24
Q

When should anticoagulation be given for AF?

A

CHADSVAS sore:
0 - no anticoagulation
1 - consider in males (not females)
2 or more - offer anticoagulation

25
Q

What is the CHADSVAS score?

A 
Congestive heart failure (1)
Hypertension (1)
Age > 75 (2)
Diabetes (1)
Stroke or TIA (2)
Vascular disease (1)
Age 65-74 (1)
Sex - female (1)
26
Q

How does warfarin work?

A

its a vitamin K antagonist which increases the prothrombin time.

27
Q

What is the goal INR for patients with AF on warfarin?

A

between 2-3

28
Q

Why does warfarin react with so many other drugs?

A

Because it is affected by the cytochrome P450 system in the liver.

Often affected by antibiotics.

29
Q

IF theres too much bleeding with warfarin, how can it be reversed?

A

vitamin K

30
Q

Why are NOACs/DOACs used instead of warfarin?

A 
They don't need to be monitored 
low half life (7-12hrs)
lower risk of bleeding 
no major interactions with medication
equal or slightly better at preventing strokes
31
Q

What is one down side of using NOACs/DOACs?

A

Their effect cannot be reversed.

32
Q

What score is used to determine the risk of bleeding?

A

HAS-BLED score.

33
Q

where does most blood stagnate in the heart?

A

The left atrium

34
Q

What other treatments can be given to AF?

A

PAcemaker
Radiofrequency ablation
AV node ablation (MUST give pacemaker if doing this)

35
Q

What is the CHA2DS2-VASc score?

A

Chronic heart failure
Hypertension
Age >75 (2)

Diabetes
Stroke (TIA or thromboembolism) (2)

Vascular disease (MI, PAD, aortic plaque)
Age 64-74
Sex - female

exams - cardio (megan) (11 decks)

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