Atrial Fibrillation Flashcards
What is a risk factor to developing AF?
-HTN, IHD, Structural heart diseases, DM, Thyrotoxciosis, Alcohol, COPD
If AF starts within 48 hours what is it classed as?
Acute AF
If AF lasts over 48 hours what type of AF is this?
Chronic
What happens in the body during AF?
Irregular, rapid atrial rate (300-600bpm) secondary to chaotic conduction within atria.
What is the ventricular rate during AF?
100-180 bpm
What does sluggish atrial blood flow allow in patients with AF?
Partial activation of the clotting cascade
What are the common symptoms of AF?
*Some asymptomatic
*SOB, Dizzy, Fatigue, Palpitations
What are the complications of AF?
Heart failure
Angina
Thromboembolism (stroke)
How is AF managed?
Stroke prevention
Rate control
Rhythm control
How is stroke risk assessed?
CHA2DS2-VASc stroke risk score
-Consider anticoagulation
-Assess the bleeding risk via ORBIT score
What are examples of DOACS?
Apixaban, Rivaroxaban, Edoxaban, Dabigatran
What surgical procedure can open up / prevent blood clots from forming due to AF?
Left atrial appendage occlusion - only used if anti-coagulation is not tolerated or is contraindicated
What is the first line strategy for AF?
Rate control
When is Rate control not used for first line for AF?
-Reversible cause (infection)
-Heart failure caused by AF
-New onset AF (within last 48 hours)
What is the second line rate control strategy for AF?
Standard B-blockers - (Bisoprolol)
OR
Rate limiting CCB
(Diltiazem or Verapamil)
If a patient has a sedentary lifestyle what drug would be given for rate control in AF?
Digoxin
If monotherapy for rate control doesn’t control the AF what should be done?
Combine 2 drugs
-B-blocker,
-Diltiazem
or Digoxin!
What is the actual first line for new onset of AF?
Cardioversion
What is the first line therapy for Rhythm control in AF?
Cardioversion
What is the second line therapy for Rhythm control in AF?
1st - Standard b-blocker (bisoprolol)
or Dronedarone
or Amiodarone
If a patient is in Heart Failure, what drug would be preferred for rhythm control?
Amiodarone
What drug is used to treat Paroxysmal (PAF) attacks of AF?
Flecainide
What shouldn’t be used for attacks (paroxysmal) of AF?
Digoxin
What do you do if other treatment has failed to control symptoms of AF or is unsuitable?
*Left atrial ablation
-RF ablation a point in left atrium where arrhythmia generated
*Pace and ablate
-RF ablation of AV node and pacemaker
