Atrial Fibrillation Flashcards
What is Atrial Fibrillation?
Sustained cardiac arrhythmia
AF is a key risk factor for ischemic stroke.
What are the three types of recurrent Atrial Fibrillation episodes?
- Paroxysmal - AF episodes that stop spontaneously (episode < 7 days)
- Persistent - AF does NOT terminate spontaneously (episode > 7 days)
- Permanent - Consistent AF
What are common symptoms of Atrial Fibrillation?
- Palpitations (fast/flutter)
- Dyspnoea
- Chest pain
What is a key sign of Atrial Fibrillation?
Irregularly irregular pulse.
What blood tests are relevant in the investigation of Atrial Fibrillation?
- FBC (anaemia)
- U&Es (For HAS-BLED scoring)
- LFT
- Thyroid function
What is the goal of Atrial Fibrillation management?
- Rate control
- Rhythm control
- Rduce risk of stroke.
What is the first line treatment for rate control in Atrial Fibrillation?
Beta-blocker
OR
Rate-limiting calcium channel blocker (e.g. Diltiazem, Verapamil).
What are the second line treatments for rate control in Atrial Fibrillation?
Combination therapy: any 2 of the following - add into existing 1st line:
* Beta-blocker
* Rate-limiting calcium channel blocker e.g. Diltiazem
* Digoxin
What is the primary aim of rhythm control in Atrial Fibrillation?
To achieve normal sinus rhythm through cardioversion which can either be pharmacological or electrical.
What is the CHA2DS2-VASc score used for?
Calculating the risk of stroke to determine anticoagulation therapy.
What does a CHA2DS2-VASc score of 0 indicate?
No treatment.
What does a CHA2DS2-VASc score of 1 indicate for males and females?
- Male (consider anticoagulation),
- Female (no treatment).
What is the recommendation for anticoagulation therapy for a CHA2DS2-VASc score of 2 or more?
Offer anticoagulation in M/F
What type of echocardiogram should be completed in patients with Atrial Fibrillation?
Transthoracic echocardiogram to look for valvular heart disease.
What scoring system is used to assess bleeding risk before starting anticoagulants?
ORBIT
What are the first-line for Atrial Fibrillation to reduce stroke risk?
DOACs:
Apixaban
Dabigatran
Rivaroxaban
What is the second-line anticoagulant treatment for Atrial Fibrillation to reduce stroke risk?
Warfarin.
How is rhythm control managed in AF treatment?
1) Electrical cardioversion - DC syncronised shock
2) Pharmacologcial management + manage underlying cardiac conditon
What drugs are used for pharmacological cardioversion in AF?
- Amiodarone instructural heart disease
- Flecainide or amiodarone in those without structural heart disease
When is electrical cardioversion used - timings?
AF onset < 48hr: IV heparin + immediate shock
AF onset > 48hr: at least 3 weeks of anticoagulant prior to shock
What must be done for patients with Atrial Fibrillation after a stroke or TIA?
Exclude hemorrhage before starting antiplatelet or anticoagulation therapy.
What is the immediate action after a TIA in patients with Atrial Fibrillation?
Start anticoagulation immediately.
What is the protocol for starting anticoagulation therapy after a stroke?
Start antiplatelet immediately, then stop and start anticoagulation therapy after 2 weeks.
What are the long-term prevention options for Atrial Fibrillation post-stroke?
- Warfarin
- Direct thrombin/factor Xa inhibitors.
Fill in the blank: Atrial Fibrillation is a key risk factor for _______.
ischemic stroke.
True or False: All patients with Atrial Fibrillation require rhythm control as the first line of treatment.
False.
Common ECG changes seen in AF?
- No P waves
- Irregularly irregular rhythm
- Fibrillatory waves (f waves)
