Atrial Fibrillation

Question 1

What are the symptoms of Atrial Fibrillation?

Answer 1

Asymptomatic
palpitations
SOB
Faintness / dizziness
Tiredness
weakness

Question 2

examination signs of atrial fibrillation

Answer 2

Irregularly Irregular pulse.
Apical rate greater than radial rate.
Variable pulse volume.

Question 3

What are the risk factors of atrial fibrillation?

Answer 3

1) Rheumatic fever
2) alcohol intoxication
3) thyrotoxicosis (hyperthyroid)
4) Hypertension
5) Ischaemic heart disease
6) excess alcohol
7) Pneumonia
8) Pericarditis / endocarditis
9)

Question 4

What is paroxysmal atrial fib

Answer 4

recurring, sudden episodes of symptoms. (comes and goes within 7 days but usually <2)

Question 5

What is persistent A-fib?

Answer 5

Afib that lasts more than 7 days and is unlikely to go back to normal without treatment.
Can be reverted back to normal rhythm with cardioversion. (but this is temporary)

Question 6

What is permanent AFib?

Answer 6

Afib present long term.
unsuccessful cardioversion or not tried.
The heart rate can be lowered but rhythm remains irregular.

Question 7

What investigations should be done for Afib?

Answer 7

1) ECG (absent P wave, irregular rhythm, fast rate (120-180/min)
2) Bloods (thyroid function test, U+Es, cardiac enzymes e.g. troponin.
3) Echocardiogram for left atrial enlargement, mitral valve disease ect.

Question 8

what is the trearment for acut afib, in a unwell haemodynamically unstable patient?

Answer 8

• Oxygen
• cardioversion or amiodarone
• anticoagulant (heparin)
• treat underlying condition e.g. alcohol toxicity, chest infecion, hyperthyroidism

Question 9

how do you treat paroxysmal afib?

Answer 9

flecainide prn (pill in pocket)

Question 10

How do you manage chronic afib?

Answer 10

1) Ventricular rate control: AV node slowing agents (Bblocker or CCblocker) + WARFARIN
2) Rhythm control: Cardioversion + anticoagulation

Question 11

In which Afib patients is anticoagulation necessary?

Answer 11

If the patient has Afib and 1 major risk factor such as:

• Prosthetic heart valve,
• Rheumatic mitral valve disease
• History of TIA

OR

If patient has Afib and 2 moderate risk factors of CHAD2:

• Congestive heart failure
• hypertension
• age >75
• Diabetes
• stroke/TIA (scores 2)