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Cardiovascular system > Atrial fibrillation > Flashcards

Atrial fibrillation Flashcards

1
Q

Describe atrial fibrillation

A

supraventricular tachyarrhythmia
uncoordinated atrial contraction
irregular and frequently fast ventricular rate

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2
Q

What are the 5 AF patterns?

A

First diagnosed AF (AF that has not been diagnosed before)

Paroxysmal AF (self-terminating normally within 48 hours)

Persistent AF (AF that lasts longer than 7 days)

Long-standing persistent AF (continuous AF for >1 year)

Permanent AF (AF that is accepted by the patient and physician, no rhythm control interventions)

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3
Q

AF symptoms

A

palpitations
dyspnoea
chest tightness
fatigue/lethargy
sleeping disturbance
psychological effects

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4
Q

AF ECG signs

A

irregularly irregular heart rate
absent p waves

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5
Q

Cardiac causes of atrial fibrillation

A

ischaemic heart disease
hypertension
rheumatic heart disease
peri/myocarditis

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6
Q

Non-cardiac causes of atrial fibrillation

A

dehydration
endocrine causes (eg. hyperthyroidism)
infective causes (eg. sepsis)
pulmonary causes (eg. pneumonia or PE)
environmental toxins (eg. alcohol abuse)
electrolyte disturbances (eg. hypokalaemia, hypomagnesaemia)
ageing
obesity
sleep apnoea

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7
Q

Signs of AF

A

irregularly irregular pulse rate
single waveform on JVP (due to loss of a wave)
apical to radial pulse deficit (not all atrial pulses are mechanically conducted to ventricles)
variable intensity first heart sound on auscultation

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8
Q

What is fast AF?

A

ventricular rate >100bpm
normally needs some form of immediate treatment

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9
Q

What is the treatment for a patient in fast AF who is haemodynamically unstable?

A

immediate DC cardioversion

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10
Q

When should rate control not be offered in AF?

A

when AF has a reversible cause
heart failure primarily caused by AF
new onset AF
if rhythm control would be more suitable on clinical judgement

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11
Q

AF investigations

A

12-lead ECG
BP
Bloods - FBC, U&E, LFT, TFT, Coag
Echocardiogram
Holter monitoring - symptom/rhythm correlation, AF burden, ventricular rate control

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12
Q

What is a holter monitor?

A

a wearable device that records the heart’s rhythm

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13
Q

How is rate control offered in AF?

A

beta blockers (eg. bisoprolol) or rate-limiting calcium channel blocker (eg. diltiazem) should be initial monotherapy

consider digoxin monotherapy for people with non-paroxysmal AF only if they are sedentary

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14
Q

How does AF cause strokes?

A

blood pools in the atria
blood clot forms
whole or part of blood clot breaks off
blood clot travels to the brain and blocks a cerebral artery causing a stroke

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15
Q

What 2 methods can be used to achieve rhythm control in AF?

A

electrical cardioversion
pharmacological cardioversion

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16
Q

How and when is Flecainide used in AF?

A

can be given regularly or a ‘pill in the pocket’ for when symptoms occur
preferred in young patients with structurally normal hearts

17
Q

What can Flecainide do to structurally abnormal hearts?

A

induce fatal arrhythmias

18
Q

When is Amiodarone used in AF?

A

extremely effective in controlling rate and rhythm
lots of side effects
only usually given to older, sedentary patients

19
Q

When is Sotalol used in AF? What sort of drug is it?

A

beta blocker with additional potassium channel blocker action
used for those who don’t meet the demographics for flecainide or amiodarone

20
Q

Why should AF patients be anticoagulated?

A

risk of stroke

21
Q

What does CHADS2VASc score measure?

A

stroke risk for patients with AF

22
Q

How should CHADS2VASc2 score be interpreted?

A

men score >=1 need anticoagulation
women score >=2 need anticoagulation

23
Q

What scoring system stratifies bleeding risk on anticoagulants?

A

HASBLED

24
Q

What are the components of the HASBLED score?

A

Hypertension (1)
Abnormal renal/liver function (1 for each)
Stroke (previous) (1)
major Bleed (1)
Labile INR (1)
Elderly >65 (1)
Drugs/alcohol (1 for each)

25
Q

What does the ORBIT score measure and what does it take into account?

A

risk of bleeding (similar to HASBLED)
sex
haemoglobin
age
bleeding history
renal function
concomitant use of antiplatelets

26
Q

What anticoagulant is normally used for AF?

A

DOAC
- no monitoring
- generally lower bleeding risks

27
Q

When would warfarin be used for anticoagulation in AF?

A

valvular AF

28
Q

When can atrial ablation be used to treat AF?

A

when patient has uncontrolled symptoms and an identifiable locus in left atrium

29
Q

Complications of AF

A

heart failure
systemic emboli (ischaemic stroke, mesenteric ischaemia, acute limb ischaemia)
bleeding (GI, intracranial)

Cardiovascular system (33 decks)

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