Atrial Fibrillation

Question 1

What is AF?

Answer 1

Uncontrolled/unco-ordinated contraction of the atria causing an irregularly irregular heartbeat/ventricular rate + reduced CO

Question 2

What is the reduction in stroke risk if a patient with AF is given warfarin?

Answer 2

4%/yr –> 1%/yr

Question 3

What are the causes of AF?

Answer 3

P - Pneumonia, PE
I - IHD
R - RF valve disease
A - Anaemia
T - Thyrotoxicosis
E - Ethanol
S - Sepsis

Question 4

What are some of the signs of AF?

Answer 4

Irregularly irregular pulse
Signs of LVF - Increased RR, pink frothy sputum, fine lung crackles
Non cardiac diseases that may be causing the AF eg thyrotoxicosis
Apical pulse rate is greater than radial pulse rate

Question 5

What are some of the symptoms of AF?

Answer 5

Asymptomatic
Palpitations
Chest pain
Dyspnoea
Syncope

Question 6

What investigations can be performed in a patient with suspected AF?

Answer 6

ECG - absent P waves, irregularly irregular narrow complex tachycardia
Bloods - U+Es, TFTs, cardiac enzymes, FBCs
Echo - look for poor LA function, mitral valve disease

Question 7

What is the treatment for AF if it started less than 48hrs ago?

Answer 7

Cardioversion! - DC
OR
IV amiodarone
+ LMWH
Can still cardiovert after 48hrs, but need to do a transoesophageal echo to check no clots in atria
+ control ventricular rate - Verapamil, bisoprolol

Question 8

What is the management for chronic AF?

Answer 8

Rate control - verapamil or bisoprolol
Rhythm control - amiodarone
Anticoagulation - Warfarin unless contraindicated - use aspirin instead

Question 9

What is the management of paroxysmal AF?

Answer 9

‘Pill in pocket’ - Flecainide (or sotalol) if infrequent episodes
Still use anticoagulation

Question 10

What is the management of Atrial flutter?

Answer 10

Anticoagulation
Amiodarone to restore sinus rhythm
Amiodarone or Sotalol to maintain sinus rhythm

Question 11

What is the CHADSVASC score?

Answer 11

C - Congestive HF
H - HTN
A - Age - 65-74 (1), >75 (2)
D - DM
S - Stroke/TIA (2), Sex - F
VASC - Vascular disease
*Score used to assess whether anticoagulation needed*

Question 12

What is the HASBLED score?

Answer 12

H - HTN
A - Abnormal liver/renal function
S - Stroke
B - Bleeding
L - Labile INRs
E - Elderly (>65)
D - Drugs/Alcohol
*Score used to assess risk of major bleeding*