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Cardiovascular System > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

What is atrial fibrillation (AF).

A

Disorganized atrial activity.

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2
Q

What is the result of AF.

A

An irregular ventricular response.

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3
Q

What are some cardiac causes of AF. (6)

A 
Ischaemic heart disease. 
Myocardial infarction. 
Mitral stenosis. 
Atrial septal defect. 
Hypertension. 
Rheumatic heart disease.
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4
Q

What are some respiratory causes of AF. (4)

A

Lung disease.
Hypoxia.
Pulmonary embolus.
Pneumonia.

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5
Q

What is an endocrine causes of AF.

A

Thyrotoxicosis.

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6
Q

What are some metabolic causes of AF. (2)

A 
Hypercapnia. 
Metabolic abnormalities (los potassium, los magnesium).
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7
Q

What is an infective cause of AF.

A

Sepsis.

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8
Q

What is a lifestyle cause of AF. (3)

A

Alcohol.
Caffeine.
Post operative.

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9
Q

What are the symptoms of AF. (7)

A 
Asymptomatic. 
Chest pain. 
Palpitations. 
Dizziness. 
Dyspnoea. 
Faintness. 
Heart failure.
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10
Q

What are the clinical signs of AF. (5)

A

Irregularly irregular pulse.
With or without haemodynamic compromise.
Apical pulse is greater than the radial rate.
S1 varies in intensity.
Signs of LVF may be present.

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11
Q

What is the principal investigation for AF. (2)

A

ECG.

Also investigations into the underlying cause.

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12
Q

What is the ECG finding in AF. (2)

A

Irregularly irregular rhythm.

Absent P waves.

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13
Q

What is the treatment for chronic AF. (5)

A 
Treatment of underlying cause. 
Rate control. 
Rhythm control. 
Anticoagulation. 
DC cardioversion to return to sinus rhythm.
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14
Q

What drugs are used to rate control a patient with AF. (4)

A

Beta blockers and calcium channel blockers are the first choice.
Digoxin.
Diltiazem.
Amiodarone.

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15
Q

What drugs are used to rhythm control a patient with AF. (3)

A

Amiodarone.
Flecainide.
Sotalol.

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16
Q

What drugs are used to anticoagulate a patient with AF. (2)

A

Warfarin.

Heparin.

17
Q

What are the complications of AF. (2)

A

Systemic embolization.

Rapid ventricular rate leading to hypotension/angina/heart failure.

18
Q

Who is AF most common in.

A

The elderly (9%).

19
Q

What are some rare causes of AF. (9)

A 
Cardiomyopathy. 
Constrictive pericarditis. 
Sick sinus syndrome. 
Lung cancer. 
Atrial myxoma. 
Endocarditis. 
Haemochromatosis. 
Sarcoid. 
'Lone' AF means no cause found.
20
Q

What is AF often associated with.

A

Non-Cardiac disease.

21
Q

What blood tests should you do in a patient with AF. (3)

A

UandEs.
Cardiac enzymes.
TFTs.

22
Q

What would an echo show in a patient in AF. (4)

A

Left ventricular enlargement.
Mitral valve disease.
Poor LV function.
Other structural abnormalities.

23
Q

What is the treatment for a patient with acute AF. (7)

A

Oxygen.
UandEs.
Emergency cardioversion (if unavailable try IV amiodarone).
Treat associated illness.
Rate control (1st line: verapamil, bisoprolol; 2nd line: digoxin, amiodarone).
Anticoagulate (LMWH).
Cardioversion if 48h have elapsed or if transoesophageal echo is thrombus free).

24
Q

Why should you not give a patient beta blockers with diltiazem or verapamil.

A

There is a risk of bradycaridia.

25
Q

What is the anticoagulant of choice in acute AF.

A

Heparin (until a full risk assessment for emboli is done).

26
Q

What is the anticoagulant of choice in chronic AF.

A

Warfarin (INR 2-3).

Aspirin 300mg/d.

27
Q

How do you calculate stroke risk in patients with AF.

A

CHA2DS2-VASc score.

28
Q

What are the aspects of the CHA2DS2-VASc scoring system. (9)

A 
One point for each of:
Heart failure. 
Diabetes. 
Hypertension.
Vascular disease. 
Age >65. 
Female.

Two points for each of:
Age >75.
Prior TIA, stroke/thromboembolism.

29
Q

What CHA2DS2-VASc score is needed to consider starting the patient on oral anticoagulation.

A

1 or more.

or 2 or more if older

30
Q

What is the usual treatment for paroxysmal AF.

A

‘pill in the pocket’

31
Q

What is the drug of choice in paroxysmal AF. (2)

A

Sotalol or flecainide.

Cardiovascular System (31 decks)

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