Atrial Fibrillation

Question 1

What is atrial fibrillation (AF)?

Answer 1

supraventricular tachycardia with inappropriate electrical activity & ineffective atrial contraction

Question 2

What are possible causes of AD?

Answer 2

1. Hypertension
2. Hyperthyroidism
3. Valvular disease
4. Coronary artery disease
5. Pneumonia
6. Idiopathic
7. PE
8. COPD
9. Electrolyte disturbance
10. Alcohol abuse
11. Caffeine overdose

Question 3

What are 3 types of AF?

Answer 3

1. Paroxysmal
2. Persistent
3. Permanent

Question 4

What is paroxysmal AF?

Answer 4

terminates within 7 days

Question 5

What is persistent AF?

Answer 5

continues for >7days

Question 6

What is permanent AF?

Answer 6

cannot achieve sinus rhythm

Question 7

What is the Epi of AF?

Answer 7

• More common in elderly (very common then)

- M>F

Question 8

What are signs and symptoms of AF?

Answer 8

1. Irregularly irregular pulse
2. Palpitations
3. Chest pain
4. SOB / Fatigue

Question 9

What investigations are done for AF?

Answer 9

1. ECG
2. Bloods (LFTs, TFTs, U&Es)
3. Echocardiogram – to find cause (valvular)

Question 10

What are the ECG changes on AF?

Answer 10

1. Irregularly irregular pulse (distance between QRS not equal)
2. Absent P waves

Question 11

Why do you do LFTs, TFTs and U+Es in AF?

Answer 11

1. LFTs to show if alcohol induced
2. TFTs see if hyperthyroidism
3. U+Es show electrolyte imbalance

Question 12

What scoring system do you do to assess stroke risk?

Answer 12

CHADS-VASc

Question 13

What makes up the CHADS-VASc score?

Answer 13

1. CHF or left ventricular dysfunction: 1
2. Hypertension: 1
3. Age 75 or older: 2
4. Age 65-74: 1
5. DM: 1
6. Stroke, TIA or TE: 2
7. Vascular disease: 1
8. Female: 1

Question 14

What do you do if CHADS-VASc score>1?

Answer 14

offer DOAC

Question 15

What do you do if CHADS-VASc=1?

Answer 15

consider DOAC

Question 16

If DOAC is contraindicated what do you do?

Answer 16

offer vit K antagonist

Question 17

When do you not offer anticoagulation?

Answer 17

if no risk factors other than sex ( 1 for women, 0 for men)

Question 18

What does a higher CHADS-VASc mean?

Answer 18

Higher score = higher risk of stroke = more likely to need anticoagulation

Question 19

What are complications of AF?

Answer 19

1. Thromboembolism (stroke)

2. Worsening heart failure

Question 20

What is management of AF for Haemodynamic instability (BP<90/60)?

Answer 20

emergency electrical (DC) cardioversion

Question 21

What is the management for AF that <48hours (and haemodynamic stability)?

Answer 21

offer rate control or rhythm control

Question 22

What is the management for AF that is not <48hours (and haemodynamic stability)?

Answer 22

Offer rate control and anticoagulated for 3 weeks min

Question 23

What does anticoagulation for AF include?

Answer 23

1. Start with heparin + assess w/ CHADS-VASc for DOAC use

2. >3 weeks DC cardioversion

Question 24

What is rate control for AF?

Answer 24

1. Beta-blocker: bisoprolol
2. Rate limiting CCB (diltiazem, verapamil)
3. Add dignoxin if poorly controlled

Question 25

What is an example of a rate limiting CCB?

Answer 25

diltiazem, verapamil

Question 26

What is included in rhythm control and when?

Answer 26

-Electrical (DC) cardioversion 
OR
-Pharmacological cardioversion 
1.	Amiodarone (if IHD)
2.	Flecainide (if not IHD)

Question 27

When is rate not first line?

Answer 27

1. reversible cause of AF
2. heart failure caused by AF
3. people with new onset AF
4. people with atrial flutter suitable for ablation

Question 28

What are complications of AF?

Answer 28

1. Thomboembolism (stroke)

2. Worsening heart failure