Atrial Fibrillation Flashcards
Atrial fibrillation
Abnormal, disorganise electrical signals fired that cause the atria to quiver or fibrillate.
Rapid and irregular heartbeat
Symptoms of AF
Heart palpitations (pounding/fluttering)
Dizziness
Shortness of breath
Tiredness
Complications of AF
Stroke
Heart failure
Paroxysmal AF
Episodes stop within 48 hours, without treatment
Persistent AF
Episode lasts > 7 days
Permanent AF
Present all the time
Rate control
Controls ventricular rate
Slows heart rate to a normal or near-normal rate.
Beta blockers (bisoprolol, atenolol, carvedilol, metoprolol)
CCBs (diltiazem, verapimil)
Digoxin
Rhythm control medications
- Sodium channel blockers
- Potassium channel blockers
- Beta-blockers
- Dronedarone
Rhythm control procedures
Restores and maintains sinus rhythm
- Electrical cardioversion (electrodes placed on chest deliver electrical shock to the heart)
- Catheter ablation (catheter delivers energy to precise areas of the heart muscle, creating small scars, destroying cells that cause abnormal rhythm).
- Surgical ablation
Haemodynamic instability
Rapid pulse (>150 bpm)
Low BP (systolic <90 mmHg)
Loss of consciousness
Severe dizziness
Ongoing chest pain
Management of a person with haemodynamic instability
Emergency electrical cardioversion.
< 48 hours without life-threatening haemodynamic instability
Rate OR rhythm control
Electrical cardioversion
Amiodarone/flecainide
> 48 hours without life-threatening haemodynamic instability
Rate control
Beta-blocker
Verapamil
Maintenance drug treatment - 1st line
1st line = rate control
- Beta blockers (not sotalol)
- Rate limiting CCBs
- Digoxn
Monotherapy –> Dual therapy –> Rhythm control
Maintenance drug treatment - 2nd line
Beta blockers or oral anti-arrhythmic drug
Also given if rhythm control still required post-cardioversion.
- Sotalol
- Amiodarone
- Flecainide
- Propafenone
- Dronedarone
Paroxysmal and symptomatic AF
Ventricular or rhythm control
Standard beta blocker or oral anti-arrhythmic drug
Paroxysmal and symptomatic AF - infrequent episodes
Self-treatment
Flecainide or Propafenone (restores sinus rhythm if episode occurs)
Stroke prevention in AF
Calculate CHADSVASc score
Give anticoagulant if score > 2
Chronic HF or left ventricular dysfunction - 1
Hypertension - 1
Age (75+) - 2
Diabetes mellitus - 1
Stroke/TIA/history of VT - 2
Vascular disease - 1
Age (65-74) - 1
Sex (female) - 1
Stroke prevention - new onset AF
Parenteral anticoagulant
Stroke prevention - diagnosed AF
Warfarin or NOAC
Stroke prevention - NOAC
Given in non-valvar AF with >1 risk factor.
