Atrial Fibrillation Flashcards
EPIDEMIOLOGY: Atrial Fibrillation
- 10% of >70yrs
- 15% of Stroke patients (major complication of AF)
AETIOLOGY: Atrial Fibrillation
1. Cardiac
- Heart Failure
- IHD
- HTN
- (Mitral) valve disease
- Congenital
2. Pulmonary
- PE
- Pneumonia
- Bronchocarcinoma
3. Other
- Thyroid disease
- Alcohol
- Post-op
- Sepsis
- Antiarrhythmic drugs/Caffiene
- Low K+
- High Mg2+
CLINICL FEATURES: Atrial Fibrillation
- Irregularly irregular pulse
- SOB
- Syncope/dizziness
- Stroke/TIA
- Palpitations
- Chest discomfort
INVESTIGATIONS: Atrial Fibrillation
1. ECG
- No p wave
- Irregular QRS interval (but normal QRS)
- Normal T waves
2. Bloods
- TFTs - thyroid disease
- U&Es -renal dysfunction
- Cardiac enzymes
- Echo/CXR*
- Structural damage
What are the 2 management strategies for AF?
- Rate control OR
- Rhythm control (also DC cardioversion or catheter abalation)
- Prevent Thromboembolitic event
What are the deciding factors for rate vs. rhythm control?
1. Factors for rate
- >65 yrs
- Hx IHD
2. Factors for rhythm
- <65yrs
- Symptomatic
- 1st presentation
- Congestive heart failure
What are the main agents for rate control?
- Beta-blockers
- CCB (e.g. DILTIAZEM)
- Digoxin (not 1st line but preferred if HF as well)
What are the main agents used to control rhythm?
- Amiodarone
- Flecainide
- Sotolol
What score is used to decide if anticougulation is required?
C - congestive heart failure = 1
H - HTN = 1
A2 - Age >75 = 2
D - Diabetes = 1
S2 - Stroke = 2
V - Vascular Disease = 1
A - Age 65-70 = 1
S - Sex Female = 1
What is anticougulation strategy based on the score?
0 = No treatment
1 = If male consider OR if female no treatment
2 = Offer Anticougulation
What score is used to determine risk assessment of warfarin?
H - Hypertension (uncontrolled) = 1
A - Abnormal renal function
OR
Abnormal liver function = 1
S - Stroke Hx = 1
B - Bleeding Hx = 1
L - Labile INRs = 1
E - Elderly >65yrs = 1
D - Drugs predisposing to bleeding = 1
(antiplatelet/NSAIDs/Alcohol)
