atrial fibrillation

Question 1

AF epidemiology

Answer 1

7% admissions
M>W (men react better to treatment)

Question 2

AF risk factors

Answer 2

HT
IHD
DM
thyrotoxicosis
COPD

Question 3

AF pathophysiology

Answer 3

Irregular, rapid atrial rate secondary to chaotic conduction within the atria

Question 4

what is acute AF

Answer 4

<48hrs

Question 5

what are the three types of AF

Answer 5

paroxysmal - intermittent and self limiting
persistent - converted by treatment
permanent - failed treatment

Question 6

how is AF diagnosed

Answer 6

no P wave on ECG

Question 7

AF symptoms

Answer 7

asymptomatic
SOB
dizziness
fatigue
palpitations

Question 8

complications with AF

Answer 8

HF
angina
thromboembolism

Question 9

what assessments need to be carried out on diagnosis of AF

Answer 9

stroke risk - CHADVASc >1M or >2W - DOAC/warfarin
bleeding risk (ORBIT)
left atrial appendage occlusion if C/I anticoags

Question 10

what is a left atrial appendage occlusion

Answer 10

blocks entry of blood into left atrial appendage

Question 11

rate control in AF

Answer 11

• BB and/or rate limiting CCB (diltiazem/verapamil) UNLESS
  ○ Reversible cause
  ○ Heart failure caused by AF
  ○ New onset AF (within 24hrs)
  
  • Digoxin - if pt is sedentary

Question 12

rhythm control in AF

Answer 12

• Electro cardioversion 1st line
  
  • Beta blocker
  • Dronedarone
    Amiodarone

Question 13

what happens if treatment failure in AF

Answer 13

• Left atrial ablation - RF ablation at point of arrythmia generation
  Pace and ablate - RF ablation of AV node and pacemaker

Question 14

how is paroxysmal AF treated

Answer 14

• Pill in pocket flecainide to treat attacks prn
  
  • NO DIGOXIN
  • Antithrombotic
  • No caffeine/alcohol