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PR - CARDIOVASCULAR SYSTEM > ATRIAL FIBRILLATION > Flashcards

ATRIAL FIBRILLATION Flashcards

1
Q

Atrial fibrillation

A

fast and irregular heart rhythm originates in atria, overriding the SAN which is the hearts natural pacemaker
leads to irregular ventricular rhythm

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2
Q

AF and stroke

A
  • increases risk of stroke
  • CHA2D2Vasc
  • men 1, women 2
  • Give DOAC
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3
Q

What complications can AF lead to?

A

Stroke
Clot - blood doesn’t fully eject

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4
Q

ventricular rate of untreated AF

A

160-180bpm, typically slower in elderly

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5
Q

Ectopic beats

A

spontaneous
rarely requires treatment
if treatment needed: beta blockers

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6
Q

What are the two
types of management approaches for AF?

A

Rate control
- Controlling the ventricular rate
AND

Rhythm control
- Maintaining sinus rhythm

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7
Q

Rate control is first line in AF, except in patients…

A
  • AF with a reversible cause
  • Heart failure caused by AF
  • New-onset (<48 hours) AF, in which case you give rhythm control (as it is preferred)
  • Or when rhythm control is deemed more suitable
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8
Q

What is acute/ new onset AF?

A
  • AF occuring within 48H
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9
Q

Haemodynamic instability

A
  • Symptomatic hypotension
  • Acute HF
  • Unstable angina
  • Loss of consciousness
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10
Q

Treatment of acute AF
Patients with life-threatening haemodynamic instability caused by AF:

A
  • Emergency electrical cardioversion
  • Must not wait until anticoagulation is achieved - must be adminstered parenteral anticoagulation e.g. heparin
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11
Q

Treatment of acute AF
Patients without life-threatening haemodynamic instability:

A
  • If onset of AF is < 48 hours → rate OR rhythm control
  • If onset of AF is > 48 hours → rate control
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12
Q

If onset of AF is < 48 hours

A
  • Rhythm control preferred
  • Determine whether there is any structural or ischaemic heart disease present
    YES = IV amiodarone only
    NO = IV fleicanide/ IV amiodarone
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13
Q

What is suggestive of structural or ischaemic heart disease?

A
  • Left ventricular hypertrophy
  • Bundle branch block
  • Cardiomyopathy
  • Ischaemia
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14
Q

Can IV Flecainide be given to someone who has structural/ ischaemic heart
disease and has acute
AF occurring within 48 hours?

A

NO
Only IV Amiodarone

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15
Q

What about if urgent rate control is needed rather than rhythm in those who have acute
AF within 48 hours, what medication would you give?

A

IV Verapamil or IV beta-blocker can be given

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16
Q

If onset of AF is > 48 hours

A

Rate OR Rhythm control based on clinical circumstance
- However, Rate control is more preferred

17
Q

If Rhythm control is chosen for those who have acute AF more than 48 hours, what does it involve?

A
  • Electrical cardioversion (rather than pharmacological in <48 hours acute AF)
18
Q

Which pharmacological cardioversion
medication may be considered before and after electrical cardioversion?

A
  • Amiodarone may be considered
  • 4 weeks before electrical cardioversion
  • Continue for up to 12 months after electrical cardioversion to maintain sinus rhythm
19
Q

How must those who are undergoing electrical
cardioversion as part of rhythm control in acute AF >48 hours/ uncertain receive anticoagulation?

A
  1. Anti-coagulate for 3 weeks
  2. Give rate control therapy in the mean time
  3. Undergo electrical cardioversion
20
Q

What happens if
urgent anticoagulation therapy is needed prior to electrical cardioversion?

A

Give parenteral anticoagulation e.g. Heparin
Oral anticoagulation should then be given after
cardioversion and continued for at least 4 weeks

21
Q

Maintenance treatment of AF

A

Rate control with monotherapy
1. beta blocker (not sotalol)
or
2. rate limiting CCB = diltiazem or verapamil
3. digoxin

Rate control with dual therapy: 2 of the above drugs

Rhythm control

22
Q

When would you consider rate control treatment of AF with digoxin

A
  • Digoxin is ONLY effective at rest
  • Therefore it is given to those who are sedentary
  • It may also be used in those with congestive heart failure
23
Q

If monotherapy fails in rate control for AF, what do you do?

A

Combination, so 2 of either:
- Beta-blocker
- Digoxin
- Diltiazem

24
Q

If combination therapy fails, what do you do?

A

Consider Rhythm control
* pharmacological or electrical is based on clinical judgement
* Electrical would be preferred in Non-acute AF, since it would have lasted more than 48 hours

25
Q

What is involved in pharmacological rhythm control for non-acute AF?

A
  1. First Line Standard Beta-blocker (not sotalol)
  2. If contraindicated or unsuccesstul, consider Oral anti-arrhythmic drugs such as:
    - Sotalol
    - Flecainide
    - Propafenone
    - Dronedarone
    - Amiodarone
26
Q

Maintenance: if AP present > 48 hours

A

electrocardioversion preferred
pt must be fully anticoagulated for at least 3 weeks
PO - continued for at least 4 weeks after cardio version

27
Q

Drug treatment post cardio version

A
  1. BB
  2. Other antiarrythmic drug

Fleicanide
Propafenone
Amiodarone
Dronedarone
Sotalol
F PADS

28
Q

Paroxysmal AF treatment

A
  1. BB (not sotalol)
  2. if symptoms persist or a standard BB not appropriate = F PADS
29
Q

What is the pill in the pocket?

A
  • For P AF - some pt may have infrequent episodes
  • pt takes oral fleicanide/ propafenon prn with symptoms
30
Q

Which class of anti arrhythmic drugs should not be given to pt with ischaemic or structural heart disease

A

class 1c: e.g. flecainide, propafenone

31
Q

Overall which drugs are given for rate control?

A
  • Main BB (not sotalol) and RL CCB (e.g. diltiazem, verapamil)
  • Digoxin - only in sedentary pt and in HF
32
Q

Overall which drugs are given for rhythm control?

A

F PADS

PR - CARDIOVASCULAR SYSTEM (48 decks)

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