Atrial Fibrillation Flashcards
When would you refer a patient with AF to A &E
Patients ecxhibitng signs of haemodynamic instability
Signs of stroke or other serious associated or underlying condition
What are potential underlying causes of AF?
Cardiac causes-hypertension, valvular heart disease, heart failure
Respiratory cause:
chest infection, lung cancer
Systemic causes:
excessive alcohol intake , hyperthyroidism, electrolyte depletion, infection or diabetes mellitus.
How is atrial fibrillation treated?
If underlying cause is found, treatment may only be needed for this
No underlying treatment is found:
Medicines to reduce the risk of a stroke
medicines to control AF
catherteralation
having a pacemaker fitted
What are goals with rate control drugs?
Ventricular rate should be controlled between 60 and 80 bpm at rest
90-115 BPM during moderate exercise
These may need to be adjusted depending on level of exercise person can manage
what are second/third line options
Offer alternative rate control
take maximum drug dose
consider combination of beta blocker, digoxin , diltiazem (off label use)
What FIVE classes of drugs are used to treat atrial fibrillation?
Beta blockers
Digoxin
Diltiazem and verapamil
asprin and clopidogrel
amiodarone
soltalol
What are signs and symptoms of AF?
ECG with missing P waves, chaotic baseline and irregular ventricular rate
Ventricular rate - 160-180 beats per minute
Fatigue
chest pain/discomfort
lightheadedness
reduced ability to exercise
SOB
weakness
what are differential diagnoses of an irregular pulse ?
Atrial flutter-saw tooth pattern of regular atrial activation on ECG
Atrial extrasystoles — common and can cause irregular pulse
Ventricular ectopic beats.
Sinus tachycardia — sinus rhythm with more than 100 beats per minute.
Supraventricular tachycardias, including atrial tachycardia, atrioventricular nodal re-entry tachycardia, and Wolff-Parkinson-White syndrome.
Multifocal atrial tachycardia — often seen in people with severe pulmonary disease.
Sinus rhythm with premature atrial or ventricular contractions.
What two things need to be assessed in patients with AF and how?
stroke- CHA2S2VASc score
bleeding risk- ORBIT
What would you offer a patient with AF and CHA2DSVASc score of 2 or more OR CVS score of 1 in men?
offer direct acting anticoagulant. (DOAC)
who would you NOT offer DOAC to?
Patients with low chance of stroke 0 for men or 1for women
patients who cannot tolerate DOAC - vit K antagonist
What is first line for AF?
Standard BB
Rate-limiting CCB
OR
Digoxin
