Atrial Fibrillation Flashcards
What is atrial fibrillation?
Uncoordinated, rapid atrial contraction
What are symptoms?
Asymptomatic Palpitations Lightheadedness Syncopy SoB Stroke- if clot forms
What are causes of AF?
Sepsis Mitral valve disorder IHD Thyrotoxicosis HTN
How is it diagnosed?
ECG
Absence of p waves
Tachycardia
Irregularly irregular
If no abnormalities then 24hr ECG required
CXR- if ?underlying resp disease
ECHO- to look for underlying heart disease
What is the indications for rhythm control?
New onset within 48hrs
Reversible cause
HF that is thought to be primarily caused by AF
Atrial flutter that is going to be treated by ablation therapy
Clinical decision that it is best choice
What is rate control?
To slow HR down to allow ventricles enough time to fill up with blood
Beta blocker e.g. atenolol 1st line
CCB e.g. dilitazem (not in HF)
Digoxin if sedentary
What is rhythm control?
Aiming to get patient back to normal sinus rhythm
Done immediately if new onset or haemodynamically unstable
If not delay for 3 wks (require anti coagulation)- electrical only
Can use medical cardioversion (amiodarone) or electrical
Can use flecainide if no evidence of structural or ischaemic heart disease
What is long term management of rhythm control?
1st line beta blockers
2nd line dronedarone
Amiodarone if HF or LV dysfunction
What is paroxysmal AF?
When AF comes and goes
Pt should still be anti coagulated based on CHAD score
Take medication when episodes comes on
Flecanide is used for this
Why do patients with AF require anti coagulation?
Increased risk of thrombus formation and therefore stroke
How is it determined if a patient needs to be on anti coagulation?
CHA2DS2VASc score
Chronic cardiac failure-1pt HTN- 1pt Age >75- 2pts Diabetes-1pt Stroke or TIA- 2 pts Vascular disease-1pt Age 65-74-1pt Sex female- 1pt
> 1 in male then start
2 in females then start
What medications are given for atrial fibrillation?
DOAC
- apixaban/rivoroxaban
- are now first line due to decreased monitoring required
Warfarin 2nd line
How can a patients bleeding score whilst on anti coagulation be calculated?
HASBLED score
HTN- 1pt Abnormal renal or liver function- 1pt each Stroke Bleeding Labile INR whilst on warfarin Elderly Drugs or alcohol- 1pt for each
How is pharmacological cardioversion achieved in acute AF?
Amiodarone- if signs of structural heart disease
Flecainide if no signs of structural heart disease.
