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Cardiovascular > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

Briefly describe the pathophysiology of atrial fibrillation (AF).

A

Arrhythmia (disrupted rhythm of the cardiac beat) originating from the atrial tissue, a common supra ventricular rhythm.

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2
Q

What are the complication associated with AF.

A

Can lead to weaken heart due to inefficient pumping of blood —> Heart failure.
Disturbed blood flow can lead to pooling of blood—> increase risk of thrombosis—> Stroke.

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3
Q

Risk factors for AF

A

Male gender
HF-leading to atrial tissue remodelling.
Congenital structural heart diseases.
Hyperthyroidism
Alcohol
Hypertension
Family history

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4
Q

Which one is not symptom of AF.
(a) Ankle oedema
(b) Palpitations
(c) Breathlessness/dyspnoea
(d)Chest discomfort
(e)Fatigue

A

(a) ankle oedema.

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5
Q

Dizziness is not symptoms of AF
(a) True
(b) False

A

(b) False

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6
Q

Asymptomatic symptoms are a presentation commonly seen in AF.
(A) TRUE
(B) FALSE

A

(A) TRUE.

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7
Q

Symptoms of AF.

A
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8
Q

What are the three classification for AF.

A

Paroxysmal
Persistent
Permanent.

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9
Q

What is AF classification for Paroxysmal AF.
(A) recurrent –spontaneously reverts to sinus rhythm within 48 hours but
up to 7 days.
(B) recurrent lasting >7 days or needs to be reverted to sinus rhythm.
(C) longstanding- Restoration to sinus rhythm not possible.

A

(A)

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10
Q

What is the AF classification for permanent AF
(A) recurrent –spontaneously reverts to sinus rhythm within 48 hours but
up to 7 days.
(B) recurrent lasting >7 days or needs to be reverted to sinus rhythm.
(C) longstanding- Restoration to sinus rhythm not possible.

A

(C)

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11
Q

What is the AF classification for persistent AF.
(A) recurrent –spontaneously reverts to sinus rhythm within 48 hours but
up to 7 days.
(B) recurrent lasting >7 days or needs to be reverted to sinus rhythm.
(C) longstanding- Restoration to sinus rhythm not possible.

A

(B)

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12
Q

Patient X has Heart failure and his medical history and drug history shows the following:

Left atrial ablation 3 years ago.
Colectomy 3 years ago
Ramipril 5 mg OD
Bisoprolol 10 mg OD
Flecainide 5mg PRN

He comes in with atrial fibrillation that has only started 48 hours. What type of AF does he have.

A

Paroxysmal AF, recurrent, spontaneously reverts to sinus within 48 hours but up to 7 days. His ablation therapy must of not worked fully.

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13
Q

How do you diagnose AF

A

Irregular pulse
Confirmed with ECG/48 hour ECG tape.
ILR implantable loop recorder .

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14
Q

What further investigations can be carried out to confirm AF.

A

Echocardiogram.
Blood test: FBC; U/Es.
Thyroid Function tests.
Chest X-ray.

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15
Q

What is the first and second line line therapy in AF.

A

Rate control is first line therapy and rhythm control is second line therapy.

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16
Q

First line rate control agent for AF

A

Standard beta blocker: bisoprolol or a rate-limiting calcium channel blocker.

17
Q

First line for people who do little exercise or c/I for CCB or Bisoprolol.

A

Digoxin.

18
Q

What is the next step when patient is not managed on bisoprolol well for AF (monotherapy).

A

Monotherapy doesn’t work combination therapy of any 2 of the following:
Beta‑blocker
Diltiazem
digoxin

19
Q

For patient with atrial fibrillation and concomitant heart failure what is the line of therapy.

A

ACE-inhibitor and beta-blocker.
[MDC trial showed beta blockers reduced the CVD mortality in CHF patient and CONSENSUS trial showed ACE-I reduced mortality]

20
Q

For rhythm control what is the management plan.

A

Electrical shock: Cardioversion, or Left appendageal ablation.
Pharmacological: Amiodarone, flecainide, Dronaderone.

21
Q

Which one is rate controlling drug used in AF
(A) Bisoprolol
(B) Amiodarone
(C)Flecainide
(D) Diltiazem
(E) Amlodipine

A

(A) and (D)

22
Q

Which one is a rhythm controlling drug used in AF
(A) Verapamil
(B) Sotalol
(C)Bisoprolol
(D)Amiodarone
(E) NSAID

A
23
Q

Apart from assessing cardiac function what other test would be carried out in this patient population.
Atrial fib

A

CHA2D2-Vasc Score to assess stroke risk.

24
Q

Patient R comes in and tells you her job is mainly computer based and due to her disability she doesn’t do a lot of exercise. Which AF drug is best for her?

A

Digoxin 125 mag after loading dose.

25
Q

Patient L comes in and tells you that they have been taking bisoprolol and their heart rate has been controlled. However, they are still getting chest pains that they had before AF. What should they do.

A

Referral for cardioversion.

26
Q

Patient L comes into your local pharmacy demanding that she should be switched to a better heart rate control medicine. She later tells you her dose of bisoprolol is 10 mg OD. What should be done next.

A

Combinatory rate control of any of the two following:

Beta blocker.
Digoxin.
Diltiazem (off-label use).

Cardiovascular (9 decks)

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