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Year 5 Cardiology > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

what is the definition of atrial fibrillation

A

rapid, chaotic, ineffective atrial electrical conduction

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2
Q

what are the types of atrial fibrilllation

A

permanent
persistent
paroxysmal

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3
Q

what is the aetiology of atrial fibrillation

A
  1. idiopathic

2. secondary causes which lead to abnormal atrial electrical pathways

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4
Q

what are the secondary systemic causes of atrial fibrillation

A

thyrotoxicosis
HTN
pneumonia
alcohol

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5
Q

what are the secondary cardiac causes of atrial fibrillation

A 
mitral valve disease
IHD
rheumatic heart disease
cardiomyopathy
pericarditis
sick sinus syndrome
atrial myxoma
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6
Q

what are the secondary respiratory causes of atrial fibrillation

A

bronchial carcinoma

PE

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7
Q

what is the epidemiology of atrial fibrillation

A

increases with age

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8
Q

what history is associated with atrial fibrillation

A

often asymptomatic
palpitations/dizziness
symptoms of cause of AF

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9
Q

what are the examination findings in atrial fibrillation

A

irregularly irregular pulse
difference in apical beat and radial pulse
examine for thyroid disease and valvular heart disease

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10
Q

what investigations would be completed for suspected atrial fibrillation

A
  1. ECG
    -uneven baseline
    -absent p waves
    -irregularly irregular QRS complexes
  2. Blood
    -cardiac enzymes
    -TFTs (thyrotoxicosis)
    -Mg, Ca, (risk of digoxin toxicity with low K, Mg, Ca)
  3. TTE
    -assesses mitral valve disease (MS), LA dilation, LV dysfunction
    4 TOE
    -for LA thrombus
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11
Q

what would be the management for atrial fibrillation

A

TREAT ANY REVERSIBLE CAUSE

  1. Rhythm control
    - anticoagulate for 3-4wks before cardioversion
  2. Rate control
    - permanent AF
    - ventricular rate control with beta blockers or a rate-limiting/non-dihydropyridine CCBs (diltiazem)
    - aim for 90bpm
  3. Stroke risk stratification
    - low risk-aspirin
    - high risk-warfarin
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12
Q

what are the different types of cardioversion

A
  1. DC cardioversion
  2. Chemical cardioversion
    - flecainide (unless history of IHD)
    - amiodarone
  3. Prophylaxis against AF
    - flecainide
    - amiodarone
    - satolol
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13
Q

what are the stroke risk factors in atrial fibrillation

A
  1. Previous thromboembolic event
  2. Age>75yrs
  3. HTN
  4. Diabetes
  5. Vascular disease
  6. Clinical evidence of valve disease/HF/impaired LV fucntion
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14
Q

what are the complications associated with atrial fibrillation

A
  1. VTE/TE (4% stroke risk)

2. Worsens any existing HF

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15
Q

what is the prognosis in atrial fibrillation

A

chronic AF in a diseased heart is unlikely to return to sinus rhythm

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16
Q

what sort of arrythmias is AF

A

a supraventricular tachyarrhythmia

17
Q

what is the CHA2DS2VASc score

A

estimates risk of stroke in pts with AF

CCF 1
HTN 1
Age >75yrs 2
DM 1
Stroke or TIA or thromboembolism 2
Vascular disease 1
Age 65-74 1
Sex category 1
18
Q

what valvular disorder is associated with AF

A

mitral stenosis secondary to RF

19
Q

what is the management of a haemodynamically unstable AF pt

A

DC cardioversion

20
Q

what is the management for a haemodynamically stable with LA thrombus (>48hrs), AF pt without HF

A

1 rate control with BB/CCB
2 anticoagulate for 3-4wks (heparin + warfarin/NOACs) before cardioversion
3 cardioversion (DC cardioversion or chemical (flecainide, amiodarone)

21
Q

what is the INR range for AF

A

2-3

22
Q

what is the management for a haemodynamically stable with LA thrombus (>48hrs), AF pt with HF

A

1 rate control with digoxin
2 anticoagulate for 3-4wks (heparin + warfarin/NOACs) before cardioversion
3 cardioversion (DC cardioversion or chemical (amiodarone)

23
Q

when is flecainide contraindicated in AF

A

AF with HF

24
Q

how is AF treated in patients with symptoms under 48hrs

A

don’t require 3-4wk anticoagulation before cardioversion

Year 5 Cardiology (42 decks)

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