Atrial Fibrillation Flashcards

1
Q

Causes of AF?

Foci often in pulmonary veins; often only passive ventricular filling; rapid, irregular, and chaotic electrical activity in the atria

Differential?

A
  • IHD, Thyrotoxicosis, RheumHD
  • Alcohol, valvular heart disease, HTN, HF (i.e. stretch or stress on myocardium)
  • Rare: Phaeochromocytoma, IE, Pericardial disease

Venricular ectopics (can diff by increasing heart rate, should remove ectopic), Atrial flutter with variable block, other arr

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2
Q

Why is pulse not same at wrist as at apex?

A

Apex rate may be higher because AF results in variable diastolic filling of ventricles - due to variable ventricular response to atrial stimuli.

This may be enough to result in valve closure on contraction, but not enough to propagate pulse to the wrist

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3
Q

Complications of AF

A

Complications of AF

6x higher risk of stroke

HF

Cardiomyopathy

Prognosis heaviliy influenced by underlying disease state - up to 30% of people with AF will be ASx

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4
Q

Management of AF

A

Thromboprophylaxis

Rate control - Beta-blockers or cardioselective CCB (never both - riskk HF). COnsider Digoxin in HF

Rhythm control - Fleicanide (pill-in-pocket), Amiodarone, Sotalol

Cardioversion as option (if thrombus ruled out in LV)

Catheter ablation - radiofrequeny or microwave ablation of aberrant foci

Maze or more likely mini-maze (minimally invasive; microwave or cryotherapy to create the scar tissue)

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5
Q

Acute AF - with fast ventricular response

How manage if haemodynamically unstable?

If present for less than 48 hours?

More than 48 hours?

If want to cardiovert later, what have to do beforehand?

A

Acute AF - with fast ventricular response

DC cardioversion

  • If no structural heart disease - Fleicanide (careful if WPW)
  • If sturctural heart disease - amiodarone

>48h

  • x HF - BB or cardioselective CCB
  • HF - Digoxin

Place all on LMWH/Warfarin

Echo before delayed cardioversion to rule out thrombus in LV

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