Atrial Fibrillation Flashcards
List, in order, the treatment steps for AF. (7)
- Treat underlying cause
- DC cardioversion
- Rhythm control drugs
- Rate control drugs
- Anti-coagulation
- Lifestyle factors
- Procedures
Describe the CHA2DS2-VASc scoring system for stroke risk.
What is the clinical significance?
Congestive heart failure - 1 Hypertension - 1 Age 75+ yo - 2 Diabetes - 1 Stroke - 2 Vascular disease - 1 Age 65-74 yo - 1 Sex category (female) - 1
CLINICAL SIGNIFICANCE:
0-1: low risk
2+: start anti-coagulation therapy
List 2 rhythm control drugs used in AF.
In which patients would these be used? Why?
Amiodarone
Dronedone
Otherwise fit and healthy patients - because they have severe side effects which old/frail patients can’t tolerate as well
List 5 rate control drugs used in AF.
Beta blockers Digoxin Amiodarone Flecainide Rate-controlling CCBs (e.g. verapamil, diltiazem)
List 4 procedures which can be used to treat AF.
DC cardioversion
Catheter ablation
Left atrial appendage device
AF surgery
List 8 conditions which predispose to AF.
Hypertension Heart failure Valve disease Cardiomyopathies Congenital heart disease Thyroid disease Diabetes COPD
List 5 types of AF.
Silent AF
Paroxysmal AF - episodes resolve on their own
Persistent AF - AF requiring treatment
Long-standing persistent AF - AF that cannot be corrected for at least 1 year
Permanent AF - AF which cannot be corrected even by medical intervention
List 4 consequence of AF.
Thromboembolism
Microemboli
Increased risk of stroke
Impaired haemodynamics (leads to tachycardia and heart failure)
How would you measure stroke risk in AF?
CHA2DS2-VASc score
List 4 symptoms of AF.
Palpitations
Dyspnoea
Fatigue
Reduced exercise tolerance
What investigations should you do in a patient presenting with AF? (3)
CXR
ECG
Bloods (FBC, thyroid function tests)
What can precipitate episodes of AF? (6)
Thyrotoxicosis Alcohol Infection Valvular heart disease Ischaemic heart disease Rheumatic valve disease
When using rhythm control to correct AF, what is the time limit?
Why should you not use rhythm control after this point?
What SHOULD you do to treat AF after this point? (3)
48 hours
Risk of embolism if rhythm control drugs used after this point
TREATMENT:
- Control ventricular rate
- Anti-coagulation
- Recall at 6 weeks for possible cardioversion
How would you manage AF if the patient was unstable and hypotensive? (2)
- Sedation
- Synchronised DC cardioversion
ALWAYS use DC cardioversion if patient is unstable (and it’s within 48 hours); if stable, can use drugs instead
Anticoagulation is needed in AF due to the risk of thromboembolism and stroke.
Before giving anticoagulants, how would you measure bleeding risk?
Would this stop you from prescribing anticoagulants?
HAS-BLED score:
Hypertension Kidney impairment Renal impairment Age 65+ years Previous stroke Previous major bleed Labile INR Antiplatelet agents Alcohol use
High risk: 3+
STILL give anti-coagulants; BUT needs regular review and monitoring
