Atrial Fibrillation

Question 1

Initial work-up of atrial fibrillation

Answer 1

Echocardiogram (LA size (smaller=better), LV function, valve disease)

Holter monitor to assess rate
Thyroid studies
Routine CBC, BMP, Mg

Question 2

To whom should CHADS VASc score be applied?

Answer 2

Originially A-fib
Now HF
Eventually: everyone?

Question 3

disorganized rhythm, originating in left atrium

Answer 3

atrial fibrillation

rate 350+/minute electrically

Question 4

What are some symptoms of atrial fibrillation?

Answer 4

palpitations, chest pain, dyspnea, fatigue, exercise intolerance, dizziness, syncope (rare)

Question 5

Atrial fibrillation v atrial flutter

Answer 5

atrial flutter is organized, macro, slower, some mechanical function

Question 6

Options to manage atrial fibrillation

Answer 6

Rate control drugs and anticoagulation

• Mortality increased with rhythm control drugs in age 65+
• If asymptomatic, may not be necessary to correct

Rhythm control + cardioversion works about 50% of time

Pacemaker/AV nodal ablation

Catheter ablation/Surgery

Question 7

What is the CHADS2-VASc Score?

Answer 7

Risk score for atrial fibrillation

Question 8

Atrial fibrillation v atrial tachycardia

Answer 8

atrial tachycardia originates from single focus, small circuit, rates 100+/min

Question 9

Types of atrial fibrillation

Answer 9

• paroxysmal: spontaneous termination in less than 7 days (may last seconds, minutes, days)
• persistent: won’t terminate without intervention (drugs, cardioversion)
• long-standing: existed for months/years or permanent

Question 10

What are the concerns and considerations in patients with atrial fibrillation?

Answer 10

Current symptoms
Stroke
Long-term injury (tachycardia, irregular rhythm-induced cardiomyopathy)

Question 11

Mechanisms/Origin of atrial fibrillation

Answer 11

Pulmonary veins electrical impulses

Question 12

What is included in the CHA2DS2 VASc score?

Answer 12

CHF (1)
HTN (1)
Age >75 (2)
DM (1)
Prior TIA/stroke (2)
Vasc disease (1)
Age 65-74 (1)
Sex category (Female = 1)

Score 2+ –> consider treatment/anticoagulation

Question 13

Who gets atrial fibrillation?

Answer 13

More common with age
More common with other disease
Risk factors: hypertension, diabetes, M>F, W>AA

Question 14

Atrial fibrillation increases risks of

Answer 14

Mortality, Stroke

Question 15

How does atrial fibrillation affect patients?

Answer 15

Very decreased quality of life

Question 16

How does CHADS VASc score translate to stroke risk each year?

Answer 16

Score of 1 –> 1.3%
Score of 2 –> 2.2%
Score of 5 –> 6.7%
Score of 9 –> 15.2%

Question 17

Acute management of atrial fibrillation

Answer 17

If severe, acute: cardioversion
If severe, >24 hours: screen transesophageal echocardiogram
If not severe: control rate, begin anticoagulation