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A- Resp and cardio > Atrial fibrillation > Flashcards

Atrial fibrillation Flashcards

1
Q

What is AF?

A

Supraventricular tacharrhythmia characterised by ineffective, chaotic, irregular and rapid (300-600BPM) atrial activity -> deterioration of atrial mechanical function. Disorganised electrical activity

Irreguarly irregular rhythm

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2
Q

Risks for AF

A

Pirates
Pulmonary embolism
Ischaemia
Respiratory disease
Atrial enlargement or myxoma
Thyroid disease
Ethanol
Sepsis/sleep apnoea

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3
Q

Cardiac causes of AF

A

HPTN
IHD
HF
Sick sinus syndrome
Pericarditis
Infiltrative heart disease
Valvular HD - mitral
Cardiomyopathies
Myocarditis
Congenital HD

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4
Q

How to manage AF?

A
  • Rate control
    • Beta blockers, rate limiting CCBs, digoxin
  • Rhythm control - DC eletrical cardioverison or amiodarone or flecainide
  • Reduce clot risk - DOAC or warfarin
  • Test clotting risk eg
    • ORBIT scoring - replaced HASBLED ]
    • CHA2DS2-Vasc scoring
    • If chad higher than orbit offer anticoag
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5
Q

Atrial fibrillation on ECG

A

Irreguarly irregular pulse
No p waves

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6
Q

Paroxysmal vs persistent AF

A

Paroxysmal = over 30 s but under 7 days, self terminating and recurrent
Persistent = Episodes over 7 days

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7
Q

What is it called when AF fails to terminate?

A

Permanent AF
Terminated and relapses within 24 hours or long standing eg over a year

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8
Q

Rate control management in AF - when prefer over rhythm? What use?

A

BCD - over 65 or hx IHD
Beta blockers eg bisoprolol
Calcium channel blockers eg dilatezam
Digoxin

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9
Q

When is digoxin preferred in AF?

A

Co-existing HF or hypotension

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10
Q

When do you use rhythm control in AF?

A

Under 65 years, symptomatic, 1st presentation, lone AF or AF to a precipitant or CCF

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11
Q

What use in rhythm control for AF?

A

Chemical or electrical
Chemical = sotalol, Amiodarone, flecainide (in absence of structural HD)
Electrical - in acute scenario if patient is haemodynamically unstable ]or elective

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12
Q

How do you determine risk of stroke with AF?

A

CHADVASC score - need for anticoagulation vs HASBLED score - risk of bleeding with anticoagulants

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13
Q

What does the CHADVASC score consider?

A

Congestive cardiac failure
HTN
Age
Diabetees
Stroke or TIA prev = 2
Vascular disease
Sex - female = +1

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14
Q

How high does the CHADVASC score need to be to offer anticoagulation in AF?

A

> 2 or =

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15
Q

What does the HASBLED score consider?

A

HTN
Abnormal renal function or liver
Stroke or history of
Bleeding, history of or high risk of
Labile INRs (<60% therapeutic range)
Elderly
Drugs predisposing to bleeding, alcohol use

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16
Q

When is considered high risk of bleed with HASBLED score?

A

> 3 = high risk of bleeding

17
Q

Non cardiac causes af

A

Sepsis
PE
Thyrotoxicosis
Lung or pleural disease
Chest trauma
Hypokalaemia
Hypovolaemia
Hypothermia
Alcohol abuse/drug abuse eg cocaine

18
Q

Symptoms AF

A

Palpitations
Dyspnoea
Chest pain
Dizziness
Syncope
Fatigue

19
Q

Signs AF

A

Irreguarly irregular pulse
Signs of HF

20
Q

Complications AF

A

Stroke - 5x risk
HF
Tachycardia induced Cardiomyopathy + critical cardiac ischaemia

21
Q

Bloods for AF

A

FBC
U+Es
TFTs
Magnesium
LFTas
Coag screen

22
Q

Investigations AF

A

CXR - HF, mitral valve disease
ECG
ECHO - risk underlying structural/functional disease
CT/MRI brain - stroke/TIA suggestion

23
Q

AF on ECG

A

No p waves - no synchronised depolarisation
Fibrillatory waves - no baseleine
F waves = flutter waves

24
Q

Treatment for haemodynamically instability (hypotension, HF) in AF

A

Immediate elctric cardioversion

25
Q

What treat haemodynamically stable AF if <48 hours onset

A

Rate or rhythm control

26
Q

If uncertain/symptoms started over 48 hours agoAF

A

Rate control

27
Q

What need to do before cardioversion if haemodynamically stable AF with unknown onset over 48 hours if considered for long term rhythm control

A

delay cardioversion until maintatined therapeutic anticoagulation for minimum of 3 weeks

28
Q

Who is CI for rate control in AF

A

Reversible cause
HF caused by AF
New onset AF <48 hrs
Atrial flutter - condition suitable for ablation surgery to restore sinus rhythm
Ryhtm control strategy more suitable based on clinical judgement

29
Q

AF rate controlling meds

A

Beta bocker - CI asthma
CCB
Digoxin

30
Q

Rhythm control for AF

A

Beta blockers
Dronedarone
Amiodarone

31
Q

What is second line in patients following cardioversion

A

Dronedarone

32
Q

What amiodarone is particularly helpful

A

Coexisting HF with AF

33
Q

When is catheter ablation used

A

THose with AF not repsonded to or want to avoid antiarrhtyhmic meds

34
Q

What anticoagulation need to do for catheter ablation

A

4 weeks before and during the procedure
Still require anticoagulation after accoring to CHADVASC

35
Q

How long give anticoagulation based on CHADVASC score

A

0 - 2 monhts
>1 - longterm

36
Q

Complications of AF

A

cardiac tamponade
stroke
pulmonary vein stenosis

37
Q
A

A- Resp and cardio (58 decks)

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