Atrial Fibrillation

Question 1

What is AF?

Answer 1

A fast, irregular and abnormal heart beat

Question 2

What are the 3 types of AF?

Answer 2

Paroxysmal AF - terminates spontaneously, lasts <7 days (typically <24 hours).

Persistent AF - not-self terminating and lasts >7 days

Permanent AF - continuous AF, cannot be cardioverted

Question 3

What are the clinical features of AF?

Answer 3

SOB
Palpitations
Dizziness
Chest pain
Fatigue
LOC

Question 4

How would you diagnose AF?

Answer 4

Clinical diagnosis + ECG

Question 5

How do you manage AF? (Rate control)

Answer 5

Rate control - generally 1st line unless:
-Has a reversible cause of AF then rhythm control
-Has co-existent heart failure then rhythm control
-New onset AF and <48 hours then rhythm control

1st line - BBs or CCB (diltiazem or verapamil)
*Avoid BBs in asthmatics

2nd line - Digoxin

Question 6

How do you manage AF? (Rhythm control)

Answer 6

*Patient must present <48 hours to reduce risk of stroke to do cardioversion

-Pharmacological: Amiodarone (SHD present) or Flecanide (no SHD)

-Electrical cardioversion (HDUS then cardioversion)

Question 7

What are worrying signs in AF that you should be aware of?

Answer 7

Heart failure, hypotension decreased GCS or chest pain

Question 8

What scoring system is used in offering anti-coagulation?

Answer 8

0 = no treatment
1 = male, consider but not in females
2 = offer AC

Question 9

What anti-coagulation can be used in managing AF?

Answer 9

Warfarin: target INR of 2-3

DOACs: Edoxaban, Rivaroxban, Dabigatran