Atrial Fibrillation

Question 1

What is it?

Answer 1

A chaotic, irregular atrial rhythm, about 300-600bpm

Question 2

What is the result of this? (2)

Answer 2

Intermittently conduction is passed to the ventricles so there is an irregular ventricular rate and cardiac output drops 10-20%

Question 3

What causes it? (6)

Answer 3

Heart disease/ischaemia, hypertension, Mitral valve disease (causes back pressure on the left atrium), hyperthyroidism, post-infection, alcohol

Question 4

Is it common?

Answer 4

Yes very, it affects 9% of the elderly

Question 5

Symptoms (5)

Answer 5

*May be asymptomatic, Chest pain, palpitations, dyspnoea, syncope

Question 6

Signs (4)

Answer 6

Irregularly irregular pulse, apical pulse faster than radial, heart sounds of variable intensity, lack of heart sound 1

Question 7

Investigations

Answer 7

ECG, Bloods (FBC, U&E, Cardiac Enzymes (BNP)), TFTs, ECHO

Question 8

What would an ECG show?

Answer 8

Absent P waves

Question 9

Management of Acute Atrial Fibrillation (4)

Answer 9

Cardioversion, Oxygen, Amiodarone, LMWH

Question 10

Management of Chronic Atrial Fibrillation (3)

Answer 10

Anticoagulation with Warfarin or NOACs, Rate control with Beta blocker, Calcium Blocker, Amiodarone or Digoxin, Rhythm control with Cardioversion, Pacing

Question 11

What is atrial flutter?

Answer 11

Continuous atrial depolarisation at a rate of 300/min, which produces a more regular depolarisation of the Ventricles

Question 12

What would an ECG show in Atrial Flutter?

Answer 12

Produces a saw tooth baseline

Question 13

What treatment is needed? (2)

Answer 13

Cardioversion and rate control with Beta blockers or Amiodarone