Atrial Fibrillation Flashcards
What is atrial fibrillation (AF)?
supraventricular tachycardia with inappropriate electrical activity & ineffective atrial contraction
What are possible causes of AD?
- Hypertension
- Hyperthyroidism
- Valvular disease
- Coronary artery disease
- Pneumonia
- Idiopathic
- PE
- COPD
- Electrolyte disturbance
- Alcohol abuse
- Caffeine overdose
What are 3 types of AF?
- Paroxysmal
- Persistent
- Permanent
What is paroxysmal AF?
terminates within 7 days
What is persistent AF?
continues for >7days
What is permanent AF?
cannot achieve sinus rhythm
What is the Epi of AF?
- More common in elderly (very common then)
- M>F
What are signs and symptoms of AF?
- Irregularly irregular pulse
- Palpitations
- Chest pain
- SOB / Fatigue
What investigations are done for AF?
- ECG
- Bloods (LFTs, TFTs, U&Es)
- Echocardiogram – to find cause (valvular)
What are the ECG changes on AF?
- Irregularly irregular pulse (distance between QRS not equal)
- Absent P waves
Why do you do LFTs, TFTs and U+Es in AF?
- LFTs to show if alcohol induced
- TFTs see if hyperthyroidism
- U+Es show electrolyte imbalance
What scoring system do you do to assess stroke risk?
CHADS-VASc
What makes up the CHADS-VASc score?
- CHF or left ventricular dysfunction: 1
- Hypertension: 1
- Age 75 or older: 2
- Age 65-74: 1
- DM: 1
- Stroke, TIA or TE: 2
- Vascular disease: 1
- Female: 1
What do you do if CHADS-VASc score>1?
offer DOAC
What do you do if CHADS-VASc=1?
consider DOAC
If DOAC is contraindicated what do you do?
offer vit K antagonist
When do you not offer anticoagulation?
if no risk factors other than sex ( 1 for women, 0 for men)
What does a higher CHADS-VASc mean?
Higher score = higher risk of stroke = more likely to need anticoagulation
What are complications of AF?
- Thromboembolism (stroke)
2. Worsening heart failure
What is management of AF for Haemodynamic instability (BP<90/60)?
emergency electrical (DC) cardioversion
What is the management for AF that <48hours (and haemodynamic stability)?
offer rate control or rhythm control
What is the management for AF that is not <48hours (and haemodynamic stability)?
Offer rate control and anticoagulated for 3 weeks min
What does anticoagulation for AF include?
- Start with heparin + assess w/ CHADS-VASc for DOAC use
2. >3 weeks DC cardioversion
What is rate control for AF?
- Beta-blocker: bisoprolol
- Rate limiting CCB (diltiazem, verapamil)
- Add dignoxin if poorly controlled
What is an example of a rate limiting CCB?
diltiazem, verapamil
What is included in rhythm control and when?
-Electrical (DC) cardioversion OR -Pharmacological cardioversion 1. Amiodarone (if IHD) 2. Flecainide (if not IHD)
When is rate not first line?
- reversible cause of AF
- heart failure caused by AF
- people with new onset AF
- people with atrial flutter suitable for ablation
What are complications of AF?
- Thomboembolism (stroke)
2. Worsening heart failure