Atrial Fibrillation Flashcards
what is the definition of atrial fibrillation
rapid, chaotic, ineffective atrial electrical conduction
what are the types of atrial fibrilllation
permanent
persistent
paroxysmal
what is the aetiology of atrial fibrillation
- idiopathic
2. secondary causes which lead to abnormal atrial electrical pathways
what are the secondary systemic causes of atrial fibrillation
thyrotoxicosis
HTN
pneumonia
alcohol
what are the secondary cardiac causes of atrial fibrillation
mitral valve disease IHD rheumatic heart disease cardiomyopathy pericarditis sick sinus syndrome atrial myxoma
what are the secondary respiratory causes of atrial fibrillation
bronchial carcinoma
PE
what is the epidemiology of atrial fibrillation
increases with age
what history is associated with atrial fibrillation
often asymptomatic
palpitations/dizziness
symptoms of cause of AF
what are the examination findings in atrial fibrillation
irregularly irregular pulse
difference in apical beat and radial pulse
examine for thyroid disease and valvular heart disease
what investigations would be completed for suspected atrial fibrillation
- ECG
-uneven baseline
-absent p waves
-irregularly irregular QRS complexes - Blood
-cardiac enzymes
-TFTs (thyrotoxicosis)
-Mg, Ca, (risk of digoxin toxicity with low K, Mg, Ca) - TTE
-assesses mitral valve disease (MS), LA dilation, LV dysfunction
4 TOE
-for LA thrombus
what would be the management for atrial fibrillation
TREAT ANY REVERSIBLE CAUSE
- Rhythm control
- anticoagulate for 3-4wks before cardioversion - Rate control
- permanent AF
- ventricular rate control with beta blockers or a rate-limiting/non-dihydropyridine CCBs (diltiazem)
- aim for 90bpm - Stroke risk stratification
- low risk-aspirin
- high risk-warfarin
what are the different types of cardioversion
- DC cardioversion
- Chemical cardioversion
- flecainide (unless history of IHD)
- amiodarone - Prophylaxis against AF
- flecainide
- amiodarone
- satolol
what are the stroke risk factors in atrial fibrillation
- Previous thromboembolic event
- Age>75yrs
- HTN
- Diabetes
- Vascular disease
- Clinical evidence of valve disease/HF/impaired LV fucntion
what are the complications associated with atrial fibrillation
- VTE/TE (4% stroke risk)
2. Worsens any existing HF
what is the prognosis in atrial fibrillation
chronic AF in a diseased heart is unlikely to return to sinus rhythm
what sort of arrythmias is AF
a supraventricular tachyarrhythmia
what is the CHA2DS2VASc score
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
what valvular disorder is associated with AF
mitral stenosis secondary to RF
what is the management of a haemodynamically unstable AF pt
DC cardioversion
what is the management for a haemodynamically stable with LA thrombus (>48hrs), AF pt without HF
1 rate control with BB/CCB
2 anticoagulate for 3-4wks (heparin + warfarin/NOACs) before cardioversion
3 cardioversion (DC cardioversion or chemical (flecainide, amiodarone)
what is the INR range for AF
2-3
what is the management for a haemodynamically stable with LA thrombus (>48hrs), AF pt with HF
1 rate control with digoxin
2 anticoagulate for 3-4wks (heparin + warfarin/NOACs) before cardioversion
3 cardioversion (DC cardioversion or chemical (amiodarone)
when is flecainide contraindicated in AF
AF with HF
how is AF treated in patients with symptoms under 48hrs
don’t require 3-4wk anticoagulation before cardioversion
