Atrial Fibrillation

Question 1

What is AF

Answer 1

Irregular/fast beating of atria

Question 2

How common is AF

Answer 2

• V common - 5-19% pts >65yrs

- 1/3 pts after CABG + >50% undergoing valvular surgery

Question 3

What causes AF

Answer 3

• HTN
• CHD
• Valvular disease
• Hyperthyroidism
• Rheumatic fever, HF, cardiomyopathy, pericarditis, drugs, DM, cancer

Question 4

What are the risk factors

Answer 4

• Obesity, ++ alcohol, ++ caffeine

Question 5

What are the main classifications of AF

Answer 5

• Paroxysmal AF = ‘recurring sudden episodes of symptoms’ = comes and goes (within 7 days but usually <2);
• Persistent AF= lasts >7days, unlikely to revert to normal w/out treatment. Heartbeat ~ reverted to norm rhythm w/ cardioversion treatment.
• Permanent AF = AF long-term + heartbeat not reverted to normal rhythm. (+/- Cardioversion treatment). Treated to bring HR down, but rhythm stays irregular

Question 6

What are the symptoms

Answer 6

• Highly variable –> 30% = incidental finding
• Chest pain, palpitations, dyspnoea, faintness
• Ass w. angina + ankle swelling

Question 7

What are the signs

Answer 7

• IRREGULARLY IRREGULAR PULSE
• Apical pulse rate > radial pulse rate
• High BP, valve murmur

Question 8

What investigations would you perform

Answer 8

● ECG = fine oscillations of baseline (fibrillations or f waves) + absent p wave; QRS is rapid and irregular; untreated ventricular rate = 120-180/min

● Bloods: TFTs, U&Es, cardiac enzymes

● ?echocardiogram for left atrial enlargement, mitral valve disease, fibrosis

● CHA2DS2-VAS SCORE – clinical prediction rule for estimating stroke in pt w/ non-rheumatic fever

Question 9

What are the points in the CHA2DS2-VAS SCORE

Answer 9

• Congestive heart failure (L ventricular systolic dysfunction)
• HTN
• A2 = >75yrs
• Diabetes Mellitus
• Stroke (prior) TIA, thromboembolism
• Vascular disease (e.g. peripheral artery disease, MI)
• Age - 64-74years
• Sex i.e. female

Question 10

What is the treatment for AF

Answer 10

• Control rate w/ B-blocker, digoxin, verapamil (CaCB)
• Pacemaker
• Cardioversion
• Anticoagulation (warfarin)