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Cardio > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

What is atrial fibrillation

A

Irregularly Irregular atrial firing due to AV Delay

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2
Q

What is the epidemiology of AF

A

Most common Cardiac arrythmia

Increases with age

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3
Q

What is the pathology behind AF

A

Inflammation and fibrosis dilates the atria causing change in the refractory period.
Electrical re-entrant pathway is conducted in the atria leading to uncoordinated contractions.
The AVN only conducts some of these contractions leading to irregular ventricular response (Atrial Spasm and Atrial pooling)

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4
Q

How would you describe the Pulse in AF

A

Irregularly Irregular

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5
Q

What are some causes of AF

A

Heart fail
HTN
Secondary to mitral stenosis

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6
Q

What are the ris factors of AF

A 
>60
Diabetes
HTN
CAD
MI
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7
Q

What is the symptoms of AF

A

Palpitation
Chest pain
SOB
Dizzy

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8
Q

What are the signs of AF

A 
Irregularly irregular pulse
Apical>Radial pulse
Heart fail
Hyperthyroid
Alcohol Excess
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9
Q

What does an ECG show for AF

A 
Irregular Pulse
Narrow QRS
No P waves
Variable Ventricular rate
Absent Isoelectric line
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10
Q

How would you define AF

A

Ventricular rate >100bpm

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11
Q

What is the first rule of management of AF

A 
ABCDE
Asses haemodynamic stability
-Shock = end organ hypoperfusion
-Syncope = Brain hypoperfusion
-Chest pain = MI
-Pulmonary oedema = Heart fail
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12
Q

When should you offer Immediate DC CARDIOVERSION

A

If the patient is unstable

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13
Q

How would you treat the reversible causes of AF

A

Infection - give antibiotics and fluid
Dehydration - give fluids
Replace abnormal electrolytes

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14
Q

When would you offer Rate control

A

Everyone with AF EXCEPT….

  • AF with reversible cause
  • Heart failure
  • New AF onset
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15
Q

What would you offer for rate control of AF

A 
Beta Blocker (Bisoprolol) or Rate limiting CCB (Diltiazem)
Digoxin
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16
Q

When would you offer digoxin

A 
Non paroxysmal AF
Hypotensive patient
Existing Heart fail
Avoid in young patients (high mortality)
Normally used 2nd to beta blocker
17
Q

Which beta blocker cannot be used in AF

A

Sotalol

-Rhythm control action

18
Q

When are Beta blockers Contraindicated

A

COPD, Asthma and Hypotension

19
Q

Which two CCB are commonly used in AF (Non-dihyropyridine)

A

Diltiazem
Verapamil
-Not used in Hospital because negatively inotropic so CI in Heart fail

20
Q

How can you achieve Rhythm control

A

Electrical cardioversion

Pharmacological Cardioversion

21
Q

When can a patient have immediate DC cardioversion

A

When AF is Acute <48hrs

22
Q

What is the management of AF if it has been over 48hrs or the cause is uncertain

A

Anticoagulation 3 weeks before DC cardioversion

Do a Transoesophageal ECHO to rule out LA thrombus

23
Q

What is the pharmacological cardioversion drugs used in AF

A

Flecainide (Pill in pocket)
Amiadarone(Rate and rhythm control)
Sotalol (Last resort)

24
Q

What AF drug would you give to a patient who is young with structurally sound hearts

A

Flecainide

They cause arrythmias in patients with heart structure problems

25
Q

What AF drug would you give to elderly patients

A

Amiadarone

Highly effective but give to elderly because they have many side effects

26
Q

Why should anticoagulation be given with AF

A

AF has a high chance of thromboembolism thus stroke so risk needs to be decreased

27
Q

What is the scoring system for Anti-coagulation typically with AF

A 
CHADS2VASc
C- Cardiac fail = 1
H- HTN = 1
A - Age over 75 = 2
D - Diabetes Mellitus =1
S - Stroke/TIA = 2
V - Vascular disease = 1
A- Age 65-74 = 1
Sc - Female = 1
28
Q

What score is needed on CHADS2VASc for anticoagulation

A 
Male = 1 or more
Female = 2 or more
29
Q

How would you assess bleeding risk with anticoagulation

A 
HASBLED
H- HTN = 1
A- Abnormal renal/Liver function = 1 each
S- Stroke = 1
B- Bleed is major = 1
L- Labile INR = 1
E- Elderly over 65 = 1
D- Drugs and Alcohol = 1 each
30
Q

What is the newly presented score for measuring anticoagulation

A

ORBIT score

  • Sex
  • Haemoglobin (<13M OR <12F)
  • Age
  • Bleeding
  • Renal function (eGFR<60)
  • Antiplatelet use
31
Q

Why is there a high risk of stroke from AF

A

Blood stagnates in the atria due to invariable contractions and poor emptying
Blood embolises and can travel to the brain via the carotids

32
Q

What are the three forms of anticoagulation used in AF

A

DOAC
Warfarin
LMWH

33
Q

Why are DOACS the drug of choice for anti coagulation

A

Edoxaban-Apixaban-Dabigatran
Do NOT require monitoring
Less bleeding risks than Warfarin
But has short half life

34
Q

What are the characteristics of Warfarin

A

Prothrombotic so needs LMWH initially
Requires INR monitoring
But has longest half life
The only drug for Valvular AF

35
Q

Give an example of LMWH

A

Enoxaparin

36
Q

What is Atrial Ablation

A

Intervention which destroys conduction tissue

37
Q

What are the complications of AF

A

Heart fail
Embolism (stroke and ischemia)
GI Bleed

38
Q

What are the types of intervention for AF

A 
DC cardioversion (Rhythm control)
Rate control
Pharmacological Cardioversion
Anticoagulation
Atrial Ablation
39
Q

What is the HASBLED score

A

Asses risk of major bleed in AF w/anticoagulation

>3 = regular review

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