atrial fibrillation

Question 1

what are the 2 most common causes of atrial fibrillation in the developed world

Answer 1

hypertension and heart failure

Question 2

list causes of atrial fibrillation

Answer 2

hypertension
heart failure
MI
hyperthyroidism
rheumatic heart disease
sepsis
electrolyte disturbance
2-10% idiopathic

Question 3

how can atrial fibrillation be classified

Answer 3

paroxysmal = <48 hrs
persistent = >48 hrs
permanent = unable to cardiovert to normal sinus rhythm

Question 4

what are the symptoms of atrial fibrillation

Answer 4

incidental finding in ~30% patients

rapid palpitations
dyspnoea
chest pain

Question 5

what are the clinical signs of atrial fibrillation

Answer 5

irregularly irregular pulse

Question 6

what are the investigations used in atrial fibrillation

Answer 6

ECG

Question 7

what are the ECG findings in atrial fibrillation

Answer 7

atrial rate >300bpm
irregularly irregular rhythm
no P waves
narrow QRS

Question 8

what is the CHA2DS2-VASc score

Answer 8

risk stratifying tool to determine stroke risk

Question 9

what is the acute management of atrial fibrillation

Answer 9

treat provoking cause if possible
stable - rate or rhythm control
unstable - DCCV first line, pharmacological cardioversion second line)
anticoagulate with heparin or DOAC

Question 10

what is the chronic management of atrial fibrillation in elderly patients

Answer 10

rate control

first line: usually achieved by a combination of beta blockers or CCBs +/- digoxin

second line: AVN ablation

Question 11

what is the chronic management of atrial fibrillation in younger patients

Answer 11

rhythm control

first line: cardioversion DCCV or pharmacological cardioversion using class I or III anti-arrhythmics

second line: left atrial catheter ablation, Maze procedure

Question 12

describe anticoagulation in atrial fibrillation

Answer 12

prevents thromboembolic complications

indicated in underlying valvular disease and/ or CHA2DS2-VASc score >2