Atrial Fibrillation

Question 1

Why does AF cause an irregular rhythm?

Answer 1

Chaotic atrial signalling causes atrial ‘spasming’. This causes an irregular rhythm due to irregular stimulation of AVN.

Question 2

What does an ECG show with a patient in AF?

Answer 2

Irregularly irregular waves and no p waves

Question 3

What is paroxysmal AF?

Answer 3

Term used If episodes of AF terminate spontaneously. Usually last less than 7 days.

Question 4

What is persistent AF?

Answer 4

Arrhythmia is not self-terminating. Usually last longer than 7 days.

Question 5

How is permanent AF managed?

Answer 5

Rate control and anti-coagulation

Question 6

What are symptoms of AF?

Answer 6

palpitations, chest pain, dyspnoea

Question 7

What are the signs of AF?

Answer 7

irregularly irregular pulse

Question 8

How is AF managed?

Answer 8

Rate or rhythm control

Question 9

What is the predominant management approach?

Answer 9

Rate control

Question 10

What are first-line drugs are used for rate control?

Answer 10

beta-blocker or a rate-limiting calcium channel blocker (e.g. diltiazem)

Question 11

What is second line rate control treatment?

Answer 11

combination therapy with any 2 of the following:
a betablocker
diltiazem
digoxin

Question 12

When should rhythm control be considered first?

Answer 12

In a patient with coexistent heart failure, first onset AF or where there is an obvious reversible cause.

Question 13

What are the criteria for cardioversion? (2)

Answer 13

a short duration of symptoms (less than 48 hours) or

be anticoagulated for a period of time prior to attempting cardioversion.

Question 14

What is stroke risk scoring system used in AF?

Answer 14

CHA2DS2VASc

Question 15

What can be used to anti-coagulate?

Answer 15

Warfarin or DOACs

Question 16

What risk scoring is used for starting someone on warfarin?

Answer 16

HAS-BLED

Question 17

What score is considered a high-risk of bleeding?

Answer 17

3

Question 18

Which 3 medications can be used for rhythm control?

Answer 18

Solatol, amiodarone or fleicanide

Question 19

Which factors favour a rate control approach?

Answer 19

• older than 65 y/o

- history of ischaemic heart disease

Question 20

Which factors favour a rhythm control approach?

Answer 20

• younger than 65 y/o
• symptomatic
• first presentation
• lone AF or secondary to corrected precipitant
• congestive HF

Question 21

Which 2 medications can be used to pharmacologically cardiovert?

Answer 21

amiodarone

or

fleicanide (if no structural heart disease)