Atrial Fibrillation Flashcards
What is atrial fibrillation (AF).
Disorganized atrial activity.
What is the result of AF.
An irregular ventricular response.
What are some cardiac causes of AF. (6)
Ischaemic heart disease. Myocardial infarction. Mitral stenosis. Atrial septal defect. Hypertension. Rheumatic heart disease.
What are some respiratory causes of AF. (4)
Lung disease.
Hypoxia.
Pulmonary embolus.
Pneumonia.
What is an endocrine causes of AF.
Thyrotoxicosis.
What are some metabolic causes of AF. (2)
Hypercapnia. Metabolic abnormalities (los potassium, los magnesium).
What is an infective cause of AF.
Sepsis.
What is a lifestyle cause of AF. (3)
Alcohol.
Caffeine.
Post operative.
What are the symptoms of AF. (7)
Asymptomatic. Chest pain. Palpitations. Dizziness. Dyspnoea. Faintness. Heart failure.
What are the clinical signs of AF. (5)
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.
What is the principal investigation for AF. (2)
ECG.
Also investigations into the underlying cause.
What is the ECG finding in AF. (2)
Irregularly irregular rhythm.
Absent P waves.
What is the treatment for chronic AF. (5)
Treatment of underlying cause. Rate control. Rhythm control. Anticoagulation. DC cardioversion to return to sinus rhythm.
What drugs are used to rate control a patient with AF. (4)
Beta blockers and calcium channel blockers are the first choice.
Digoxin.
Diltiazem.
Amiodarone.
What drugs are used to rhythm control a patient with AF. (3)
Amiodarone.
Flecainide.
Sotalol.
What drugs are used to anticoagulate a patient with AF. (2)
Warfarin.
Heparin.
What are the complications of AF. (2)
Systemic embolization.
Rapid ventricular rate leading to hypotension/angina/heart failure.
Who is AF most common in.
The elderly (9%).
What are some rare causes of AF. (9)
Cardiomyopathy. Constrictive pericarditis. Sick sinus syndrome. Lung cancer. Atrial myxoma. Endocarditis. Haemochromatosis. Sarcoid. 'Lone' AF means no cause found.
What is AF often associated with.
Non-Cardiac disease.
What blood tests should you do in a patient with AF. (3)
UandEs.
Cardiac enzymes.
TFTs.
What would an echo show in a patient in AF. (4)
Left ventricular enlargement.
Mitral valve disease.
Poor LV function.
Other structural abnormalities.
What is the treatment for a patient with acute AF. (7)
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).
Why should you not give a patient beta blockers with diltiazem or verapamil.
There is a risk of bradycaridia.
What is the anticoagulant of choice in acute AF.
Heparin (until a full risk assessment for emboli is done).
What is the anticoagulant of choice in chronic AF.
Warfarin (INR 2-3).
Aspirin 300mg/d.
How do you calculate stroke risk in patients with AF.
CHA2DS2-VASc score.
What are the aspects of the CHA2DS2-VASc scoring system. (9)
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.
What CHA2DS2-VASc score is needed to consider starting the patient on oral anticoagulation.
1 or more.
or 2 or more if older
What is the usual treatment for paroxysmal AF.
‘pill in the pocket’
What is the drug of choice in paroxysmal AF. (2)
Sotalol or flecainide.
