Atrial Fibrillation Flashcards
What is atrial fibrillation
Irregular or disorganized electrical activity in the atria
How can you describe AF
Palpitations
Fluttering feeling
Rapid/irregular heartbeat
List the 3 types of AF
Paroxysmal
Persistent
Permanent
What is a normal heart rate
60-100 beats per mins
What is AF heart rate
160-180 beats per mins
What are the risk factors of AF
Hypertension
Diabetes
Hyperthyroidism
Heart surgery
Asthma
Lung cancer
Pulmonary embolism
What is lone AF
When there is no pre existing conditions or risk factors
What are the symptoms of AF
Chest pain
Dyspnoea (shortness of breath)
Palpitations
Syncope (fainting)
How long does lone or acute Af present for?
<48 hrs
How long does chronic AF present for?
> 48hrs
List things about paroxysmal AF
Last less than 7 days
Terminates spontaneously
List things about persistent AF
Last longer than 7 days
Does not terminate spontaneously
List things about permanent AF
Long standing AF
Does not terminate spontaneously
What is the aim of treatment ?
Prevent stroke and thromboembolism
Restore and maintain sinus rhythm
What is the assessment for stroke risk
CHADS2 - VASC score
What’s CHADS2-VASc and the score point?
C- congestive heart failure - 1
H - hypertension (140/90mmhg) - 1
A - age >75 - 2
D - Diabetes - 1
S2 - prior stroke or TIA - 2
V - vascular disease - 1
A - age (64-75) - 1
Sc - sex (females 1pt) 1
What is the assessment for bleeding risk
ORBIT or HASBLED
What is ORBIT and the scores
O - older than 75 yrs - 1
R - reduced hemoglobin - 2
B - bleeding history - 2
I - insufficient kidney function - 1
T - treatment with antiplatelet - 1
Low (0-2)
Medium (3)
High (4-7)
What is HASBLED?
H - hypertension
A - abnormal liver/renal
S - stroke
B- bleeding
L - INR
E- elderly >65
D - drugs
If someone has AF or CHA2Ds2 VASC score of 2 or above, what do you offer as first line treatment?
DOAC - Direct acting oral anticoagulant
A man with AF and CHA2DS2 VASc of 1, asses bleeding too. What do you give as first line
DOAC
List examples of DOAC
Apixaban
Edoxaban
Rivaroxaban
Dabigatran
If DOAC is contraindicated, not toenrated or not suitable, what do you give?
Vitamin K antagonist eg (warfarin)
Do not offer DOAC to or<65 with only age as risk factor. True or false
True!
After DOAC, what should you consider starting?
Drug treatment for rate control
When do you not offer rate control treatment?
Af within 48hrs
Heart failure caused by AF
Reversible cause
What are the rate control drug treatments?
Beta blockers - bisoprolol, metoprolol (except sotalol)
Rate limiting CCB - Verapamil or diltiazem
What do you give in non paroxysmal AF or if all treatment are not tolerated?
Cardiac glycoside - Digoxin
Rate control treatment is recommended for people with non acute AF. True or false
True
If mono therapy of RCT is not working, move to dual therapy?true or false
True
What do you avoid in dual therapy and why?
Anything with verapamil.
Verapamil + beta blockers are condraindicated due to a risk of reduced cardiac output and heart failure.
If RCT do not work at work, what do you use?
Amiodarone
Beta blocker except sotalol
Dronedarone
What is cardioversion
It’s a procedure used to return an abnormal heartbeat to a normal rhythm
What do you do before cardioversion
Rule out left atrial thrombus with toe and treat with heparin immediately
What do you give to treat cardioversion?
IV antiarrhythmic
Eg amiodarone or flecainide
What do you use when there is structural heart disease in cardioversion?
IV amiodarone
What do you use when there is no structural heart disease in cardioversion?
Flecainide
What do people with infrequent paroxysmal Af episode do?
Pill in pocket drugs
eg - Flecainide
Single dose- 200mg <70kg, 300>70kg
