Atrial Fibrillation

Question 1

What are symptoms?

Answer 1

Palpitations
Dyspnoea
Chest pain

Irregularly irregular pulse

Diagnosed on ECG

Question 2

When is rhythm control indicated?

Answer 2

First detected episode <48 hours
Clear and reversible trigger
Worsening features of HF

Either with medications or with electrical cardioversion

Question 3

What is rate control?

Answer 3

1) Beta blocker (bisoprolol) or rate limiting CCB (verapamil)
2) Add BB or RL-CCB (do not use together) or digoxin (esp in HF)

Question 4

Which groups should be assessed for anti-coagulation?

Answer 4

Presence of AF- permament/ paroxysmal
Atrial Flutter
Continuing risk of arrhythmia after cardioversion

Question 5

What is used to assess the risk of clot?

Answer 5

C- CHF
H- HTN
A- Age >75 (2 points)
D- Diabetes
S- Stroke ( 2 points)
V- Vascular disease
Age 65-74
Sex- Female

Score 0- non required
Score 1 in males- consider anti coag
Score 2 in females-anti coag

Anti-coagulate with NOAC

Question 6

How do we assess bleeding risk?

Answer 6

ORBIT score

Hb <130 males or <120 in females= 2 points
Age >74 years
Bleeding history= 2 points
Renal impairement <60 egfr
Treatment with antiplatelets

Total 7 points
>3 means high risk