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Medical conditions > atrial fibrillation > Flashcards

atrial fibrillation Flashcards

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USMLE® Step 1 flashcards
1
Q

atrial fibrillation (AF)

A

supraventricular tachyarrhythmia resulting from irregular and disorganised electrical activity and ineffective atrial contraction

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2
Q

first-diagnosed AF

A

not been diagnosed before regardless of symptom status, temporal pattern or duration

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3
Q

paroxysmal AF

A

terminates spontaneously within a week or with intervention and atrial remodelling has not yet occurred

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4
Q

persistent or continuous AF

A

episodes that are not self-terminating and lasts at least a year with treatment being an option for selected patients

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5
Q

permanent AF

A

atrial remodelling has occurred and lasts more than a year with treatment not being an option

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6
Q

AF pathophysiology (5)

A

electrical signals cross atria at the same time, atria quiver causing blood to pool and form a clot, some signals reach ventricles which contract irregularly, emptying of blood is impaired

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7
Q

AF complications (3)

A

thromboemboli, acute heart failure, tachycardia

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8
Q

thromboemboli complications (3)

A

stroke via carotid artery, ischaemic colitis via mesenteric arteries, acute limb ischaemia via femoral artery

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9
Q

acute heart failure complications (2)

A

pulmonary oedema via atrial regurgitation into pulmonary veins or shock via decreased cardiac output

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10
Q

tachycardia complication

A

dilated cardiomyopathy

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11
Q

stroke risk in AF patients

A

5-6 times greater than people with normal sinus rhythm

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12
Q

stroke risk after anticoagulant therapy

A

reduced by 2/3 (can prevent 6/10 strokes)

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13
Q

AF causes

A

PIRATES - pulmonary diseases, ischaemia, remodelling of atria, alcohol, thyrotoxicosis, electrolyte imbalance, sepsis

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14
Q

AF cardiac causes

A

CAD/MI, CHF, mitral stenosis (valvular AF)

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15
Q

how does CAD/MI cause AF? (4)

A

cardiac ischaemia, cardiac fibrosis, atrial remodelling, re-entrant circuits

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16
Q

how does CHF cause AF?

A

increased left atrial pressure

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17
Q

how does mitral stenosis cause AF? (4)

A

blocked blood flow to ventricles, increased left atrial pressure, atrial remodelling, re-entrant circuits

18
Q

AF non-cardiac causes (6)

A

alcohol, electrolyte imbalances, pulmonary diseases, sepsis, thyrotoxicosis

19
Q

how do electrolyte imbalances cause AF?

A

ectopic firing of atrial cells

20
Q

how do pulmonary diseases cause AF? (2)

A

hypoxia, ectopic firing of atrial cells

21
Q

how does alcohol, sepsis and thyrotoxicosis cause AF? (3)

A

increased catecholamine release, beta1-adrenoceptor activation, ectopic firing of atrial cells

22
Q

AF symptoms (7)

A

asymptomatic, chest discomfort, dyspnea, fatigue, palpitations, stroke, syncope

23
Q

AF investigations

A

ECG, echocardiogram, bloods for electrolytes and TFTs

24
Q

AF ECG

A

variable R to R interval and rapid ventricular rate

25
Q

AF echocardiogram

A

left atrial dilation and/or thrombus formation

26
Q

AF blood tests

A

hypokalemia, hypomagnesemia, hyperthyroidism

27
Q

CHADS-VASc purpose

A

assesses stroke risk

28
Q

CHADS-VASc score >2

A

high risk of stroke, offer anticoagulants

29
Q

CHADS-VASc score = 1

A

consider anticoagulants

30
Q

CHADS-VASc score = 0

A

avoid anticoagulants and use aspirin

31
Q

ORBIT scoring

A

assesses bleeding risk

32
Q

AF management (3)

A

rate control, rhythm control (for acute AF), anticoagulation

33
Q

acute AF with unstable HD management

A

emergency DCC

34
Q

acute AF with stable HD < 48 hours onset (3)

A

anticoagulation, rate control or DCC

35
Q

acute AF with stable HD > 48 hours onset (2)

A

anticoagulation, rate control

36
Q

rate control drugs

A

amiodarone, beta blockers (for HF), rate-limiting calcium channel blockers (for asthma or diabetes), digoxin (for persistent or permanent AF)

37
Q

rhythm control

A

direct current cardioversion (within 4 weeks) and/or anti-arrhythmics

38
Q

anticoagulation drugs

A

DOACs (for non-valvular AF), vitamin K antagonists/warfarin (for valvular or non-valvular AF with CKD), heparin

39
Q

supraventricular tachycardia (SVT) treatment

A

IV adenosine with myocardial nuclear imaging

40
Q

bradyarrhythmia treatment

A

atropine

41
Q

ventricular tachycardia treatments (2)

A

IV magnesium sulphate, beta blocker, atrial pacing (avoid anti-arrhythmics)

Medical conditions (4 decks)

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