Atrial fibrillation

Question 1

Common cardiac causes of AF

Answer 1

1. Ischaemic heart disease
2. Rheumatic/ valve heart disease
3. Hypertension
4. Heart failure
5. Sick sinus syndrome (malfunction of SAN)
6. Pre-exciting syndromes

Question 2

Most likely cause of AF in someone who is otherwise fit and well

Answer 2

Alcohol excess

Question 3

Respi causes of AF

Answer 3

1. Infection (esp pneumonia)
2. PE
3. Lung cancer

Question 4

Endocrine/systemic causes of AF

Answer 4

1. Thyrotoxicosis
2. Abnormal electrolytes
3. Infection
4. Diabetes
5. Stroke
6. Alcohol

Question 5

Describe paroxysmal AF

Answer 5

2 or more episodes in <48h

Question 6

When is rate control used for AF

Answer 6

1st line drugs for stable AF

Question 7

When is rhythm control (cardioversion) used for non acute AF

Answer 7

1. Reversible cause of AF (for new onset paroxysmal AF) eg chest infx
2. AF is causing or worsening heart failure

Question 8

Rate control drugs

Answer 8

1. Beta blocker
2. CCB with rate limiting properties
3. Digoxin (only in elderly)

Question 9

Rhythm control drugs

Answer 9

1. Beta blocker
2. Amiodarone (cardioversion drug)
3. Flecainide (cardioversion drug)
4. Propafenone (cardioversion drug)

Question 10

Which 3 types of pts should be given the pill-in-the-pocket strategy

Answer 10

Patients with

1. Paroxysmal AF
2. No hx of LV dysfunction/ valve problems/ IHD
3. Systolic BP >100, resting heart rate >70

Question 11

What drugs are used to prevent stroke in AF

Answer 11

Heparin
Warfarin
Apixaban
Dagibatran
Rivaroxiban
Digoxin (if sedentary elderly pt)

(dont give aspirin alone)

Question 12

Which cardioversion drugs are more effective at restoring sinus rhythm if given within 12h of onset

Answer 12

1. Flecainide (cardioversion drug)

2. Propafenone (cardioversion drug)

Question 13

Which cardioversion drugs are more effective at restoring sinus rhythm if given after 24h of onset

Answer 13

No difference among any of the drugs

1. Amiodarone (cardioversion drug)
2. Flecainide (cardioversion drug)
3. Propafenone (cardioversion drug)

Question 14

Which AF patients don’t require stroke prevention

Answer 14

<65yo, no other risk factors for stroke

Question 15

What CHADVASC score warrants treatment in females and males

Answer 15

Females: 2 or more
Males: 1 or more

Question 16

What patients would qualify for emergency electrical cardioversion

Answer 16

Onset within <48h + signs of haemodynamic instability

Tachycardia >150bpm
Hypotension sBP <90
Syncope/ dizziness
Ongoing chest pain
Increasing breathlessness

Question 17

Target rate control for AF

• at rest
• during moderate exercise

Answer 17

• at rest: 60-80 bpm

- during moderate exercise: 90-115bpm

Question 18

Components of CHADVASC

Answer 18

Congestive heart Failure
Hypertension
Age (65-74 is 1 point, >75 is 2 points)
Diabetes
Vascular disease
Stroke/ TIA/ VTE
Sex (female)

Question 19

Components of HASBLED

Answer 19

Hypertension
Abnormal kidney/ liver function
Stroke
Bleeding tendency
Labile INR
Elderly age >65
Drugs (Aspirin, clopidogrel)