Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year One - Cardiovascular System > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

What is atrial fibrillation (AF)?

A

It is where the contraction of the atria is uncoordinated, rapid and irregular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common arrhythmia?

A

AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the pathophysiology of AF

A

It is due to disorganised electrical activity that overrides the normal, organised activity from the sinoatrial node

This disorganised electrical activity in the atria also leads to irregular conduction of electrical impulses to the ventricles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the three classifications of AF?

A

Paroxysmal

Persistent

Permanent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is paroxysmal AF?

A

It is when the AF comes and goes in episodes, usually not lasting more than 48 hours

They do not last longer than 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is persistent AF?

A

It is when the AF comes and goes in episodes that do not self terminate

These episodes usually last greater than 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is permanent AF?

A

This is when there is continuous AF which cannot be cardioverted or if attempts to do so are deemed inappropriate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the five causes of AF?

A

mrs SMITH

Sepsis

Mitral valve pathology

Ischaemic heart disease

Thyrotoxicosis

Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does AF usually present?

A

Asymptomatically

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the six clinical features of AF?

A

Irregularly, Irregular Pulse

Increased Heart Rate, 300 – 600bpm

Palpitations

Dyspnoea

Syncope

Chest Pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What other condition also results in the presentation of an irregular, irregular pulse?

A

Ventricular ectopics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do we differentiate between AF and ventricular ectopics?

A

Ventricular ectopics disappear when the heart rate gets over a certain threshold

Therefore, a regular heart rate during exercise suggests a diagnosis of ventricular ectopics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What investigation is used to diagnose AF?

A

ECG scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the three signs of AF on ECG?

A

Absent P waves

Narrow QRS complex tachycardia

Irregularly irregular ventricular rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the two aims when managing AF?

A

Rate/rhythm control

Reducing stroke risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What do we usually chose to control in AF - rate or rhythm?

A

It is first line to control rate rather than rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

In what three circumstances do we chose to control rhythm over rate in AF?

A

There is a reversible cause for their AF

The AF is of new onset (within 48 hours)

The AF is causing heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What do we aim to reduce the heart rate to in AF? Why is this important?

A

< 100bpm

It extends the time during diastole when the ventricles can fill with blood, increasing CO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the three management options used to control rate in AF?

A

Beta-blocker

Calcium channel blocker

Digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the first line management option used to control rate in AF? Name an example

A

Beta-blocker

Atenolol 50-100mg once daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a common contraindication for beta-blockers?

A

Asthma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What CCB is used to control the rate of AF? When is it contraindicated?

A

Diltiazem

Heart failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When is digoxin administered to control rate in AF?

A

In sedentary patients - who do no/very little physical exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the mechanism of action of digoxin?

A

It inhibits the Na/K ATPase pump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How do we aim to control rhythm in AF? What is this called?
We aim to return the patient to normal sinus rhythm Cardioversion
26
What are the two types of cardioversion?
Immediate Delayed
27
When is immediate cardioversion conducted?
In cases where the AF has been present for less than 48 hours or they are severely haemodynamically unstable
28
When is delayed cardioversion conducted?
In cases where the AF has been present for more than 48 hours and they are stable
29
Prior to delayed cardioversion, what do we administer to patients? Why?
Anticoagulants for 3 weeks 48 hours prior to cardioversion patients may have developed a blood clot in the atria and reverting them back to sinus rhythm carries a high risk of mobilising that clot and causing a stroke
30
What are the two options for cardioversion?
Pharmacological Electrical
31
What two drugs are used in pharmacological cardioversion?
Flecainide Amiodarone
32
When is amiodarone selected in pharmacological cardioversion?
Structural heart disease
33
What is electrical cardioversion?
It involves rapidly shocking the heart back into sinus rhythm using a cardiac defibrillator machine These patients are sedated or given general anaesthetic prior to the procedure
34
What is electrical cardioversion synchronised to? Why?
R wave This is to prevent delivery of a shock during the vulnerable period of cardiac repolarisation when ventricular fibrillation can be induced
35
When is electrical cardioversion preferred over pharmacological cardioversion?
In haemodynamically unstable patients, with decompensation
36
What drug should patients be administered following electrical cardioversion? For how long?
Anticoagulants Lifelong
37
What three drugs are used to manage rhythm of AF long term?
Beta blockers Dronedarone Amiodarone
38
What is the first line long term rhythm control drug?
Beta blockers
39
What is the second line long term rhythm control drug?
Dronedarone
40
When is amiodarone used to control rhythm long term?
In patients with heart failure or left ventricular dysfunction
41
What drug class is used to reduce the risk of stroke in AF patients?
Anticoagulants
42
How can AF result in the development of a stroke?
The uncontrolled and unorganised movement of the atrium leads to blood stagnating in the left atrium, particularly in the atrial appendage This stagnated blood leads to a thrombus This clot then embolisms and travels within the blood It travels from the atria, to the ventricle, to the aorta then up in the carotid arteries to the brain It can then lodge in the cerebral arteries and cause an ischaemic stroke
43
What type of stroke does AF cause?
Ischaemic
44
What scoring system is used to assess whether a patient should be put on anticoagulants?
CHAS2DS2-VASc
45
What is the CHA2DS2-VASc score?
Congestive heart failure (1 point) Hypertension (1 point) Age > 75 (2 points) Age 65-74 (1 point) Diabetes (1 point) Prior Stroke/TIA/VTE (2 points) Vascular disease (1 point) Sex Female (1 point)
46
What management option is suggested in patients with a CHA2DS2-VASc score of 0?
No treatment
47
What management option is suggested in patients with a CHA2DS2-VASc score of 1?
Males - CONSIDER anticoagulation Females - no treatment (this is because their score of 1 is only reached due to their gender)
48
What management option is suggested in patients with a CHA2DS2-VASc score of 2?
OFFER anticoagulation
49
What is the first line anticoagulant used in AF?
Direct oral anticoagulants (DOACs)
50
What are the four DOACs used in AF?
Apixaban Dabigatran Edoxaban Rivaroxaban
51
Which DOAC is preferred in individuals with renal impairment?
Apixaban
52
What is the second line anticoagulant used in AF?
Warfarin
53
What is the mechanism of action of Warfarin?
It is a vitamin K antagonist This prolongs the prothrombin time, which is the time it takes for blood to clot
54
What is the function of vitamin K?
It is essential for the functioning of several clotting factors
55
Why is it important that we monitor Warfarin regularly?
It is affected by the cytochrome P450 system in the liver. Therefore INR will be affected by drugs that influence the activity of the P45O system It is affected by foods, particularly those containing vitamin K (leafy green vegetables) and those that affect P450 (cranberry juice, alcohol)
56
How do we monitor Warfarin?
INR (international normalised ratio)
57
What is the INR?
It is a calculation of how the prothrombin time of the patient compares with the prothrombin time of a normal healthy adult
58
What INR reading indicates a normal prothrombin time?
1
59
What is the target INR reading for AF?
2-3
60
How do we reverse the effects of Warfarin when the INR is too high or bleeding has occurred?
Vitamin K
61
What anticoagulant is contraindicated in AF?
Aspirin
62
What scoring system is used to establish a patient's risk of major bleeding whilst on anticoagulants/prior to administration?
HAS-BLED ORBIT
63
What is the HAS-BLED score?
It is a score based on... Hypertension Abnormal renal and liver function Stroke Bleeding Labile INRs Elderly Drugs/alcohol
64
What do NICE guidelines recommend in terms of assessing bleeding risk?
They state that a history of falls, old age and alcohol excess should not result in anticoagulation withholding
65
How do we manage paroxysmal AF?
A 'pill in the pocket' approach with flecanide This is where they take a pill to termite their AF when they feel the symptoms of AF staring
66
When is flecanide contraindicated? Why?
Atrial flutter It causes 1:1 AV conduction and results in a significant tachycardia
67
Do we start individuals with paroxysmal AF on anticoagulation?
Yes - we calculate their CHA2DS2-VASc score and consider a DOAC This is relevant is only a single episode

Year One - Cardiovascular System (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions