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Week 5 - Cardiology > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

Define atrial fibrillation [1]

A

sustained cardiac arrthymia caused by the chaotic electrical activity of the atria being conducted to the ventricles in a random manner

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2
Q

What are the symptoms of atrial fibrillation [6]

A
  1. may be asymptomatic
  2. palpitations
  3. dysponea
  4. rarely, chest pain
  5. rarely, syncope (loss of consciousness)
  6. may present with complications: stroke
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3
Q

How is the pulse typically described in atrial fibrillation? [1]

A

irregular irregular

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4
Q

What are the 3 types of presentation of atrial fibrillation? [3]

A
  1. paroxysmal (intermittent)
  2. persistent
  3. permanent

*can progress from paroxysmal fibrillation to persistent

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5
Q

What type of ECG may be needed to detect paroxysmal atrial fibrillation? [1]

A

prolonged ambulatory ECG (of lead I)

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6
Q

What are the typical features of an ECG in a patient with atrial fibrillation? [3]

A
  1. irregularly irregular rate (rate variable)
  2. irregular, narrow QRS
  3. no P waves
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7
Q

What condition is this? [1]

A

Atrial fibrillation

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8
Q

Define atrial flutter and its basic pathogenesis [2]

A
  • A type of abnormal heart rate, or arrhythmia.
  • It occurs when the atria beat faster than the ventricles, causing the heart rhythm to be out of sync
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9
Q

What are the typical features of an ECG in a patient with atrial flutter? [4]

A
  1. rate variable
  2. regular narrow QRS
  3. sawtooth atrial activity at 300bpm seen in leads II, III, aVF (in the inferior part of the heart)
  4. variable AV block
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10
Q

What are the potential complications of atrial flutter? [2]

A

risk of embolism and thrombosis

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11
Q

Name the conditions predisposing to, or encouraging progression of atrial fibrillation [11]

A
  1. hypertension
  2. symptomatic heart failure (NYHA class II-IV) including tachycardiomyopathy
  3. valvular heart disease
  4. cardiomyopathies
  5. atrial septal defect (and other congenital heart defects)
  6. coronary artery disease
  7. thyroid dysfunction
  8. obesity
  9. diabetes mellitus
  10. COPD and sleep apnoea
  11. chronic renal disease
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12
Q

What are the objectives of treatment of atrial fibrillation? [5]

A
  1. prevention of stroke
  2. symptom relief
  3. optimum management of associated CV disease
  4. rate control
  5. +/- correction of rhythm disturbance
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13
Q

What are the essential investigations given to a patient with suspected AF? [4]

A
  1. ECG
  2. echocardiogram
  3. thyroid function tests (TFTs)
  4. liver function tests (LFTs)
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14
Q

What are the AF guidelines on rate control? [6]

A
  1. target heart rate: <110/min
  2. if still symptomatic, aim for heart rate <80/min
  3. patients without heart failure should be started on either:
    • a beta blocker (bisoprolol/atenolol) or
    • rate-limiting Ca2+ antagonist (verapamil)
  4. do not use beta-blocker & verapamil together - makes the heart rate too slow
  5. digoxin as second-line
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15
Q

What are the major risk factors for stroke and thromboembolism in non-valvular AF? [3]

A
  1. previous stroke
  2. transient ischaemic attack (TIA)
  3. age ≥ 75 years
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16
Q

What are the clinically-relevant non-major risk factors for stroke and thrombo-embolism in non-valvular AF? [7]

A
  1. chronic heart failure
  2. moderate to severe left ventricular systolic dysfunction
    • e.g. left ventricular ejection fraction (LV EF) ≤ 40%
  3. hypertension
  4. diabetes mellitus
  5. age 65-74 yrs
  6. female sex (AF commoner in males but risker in females)
  7. vascular disease
17
Q

Define a transient ischaemic attack (TIA) [1]

A

a brief episode of neurological dysfunction caused by loss of blood flow (ischaemia) in the brain, spinal cord, or retina, without tissue death (infarction)

18
Q

What is warfarin? [1]

A

anticoagulant (blood thinner)

19
Q

What is warfarin very effective for? [1]

A

reducing the risk of stroke

20
Q

What is the problem with warfarin? [1]

A

it has a narrow therapeutic range - so it needs to be monitored closely

21
Q

Name the oral anticoagulant drug that acts as thrombin inhibitor [1]

A

dabigatran

22
Q

Name the oral anticoagulant drugs that acts as Factor Xa inhibitors [3]

A
  1. rivaroxaban
  2. apixaban
  3. edoxaban
23
Q

What are the criteria that a patient with atrial fibrillation needs to meet in order to be referred to OP specialist assesment [5]

A
  1. patients who are still symptomatic despite adequate rate control
  2. young age (<60)
  3. inadequate rate control despite beta-blocker (or calcium antagnoist) + digoxin
  4. structural heart disease on echo
  5. AF and coexisting heart failure (because drugs can affect each other)
24
Q

What are the 3 options for “rhythm control” for patients with AF? [3]

A
  1. direct current cardioversion (for persistent AF)
  2. antiarrhythmic drugs
  3. catheter ablation
25
Q

What are the 3 types of antiarrhythmic drugs (incl. drug names)? [8]

A
  1. Class 1 = Na+ channel blockers
    • flecainide
    • propafenone
  2. Class 3 = K+ channel blockers (prolong QT interval)
    • sotalol
    • amiodarone
  3. multichannel blockers
    • dronedarone
26
Q

What are the limitations with amiodarone? [3]

A
  1. has a lot of cardiac side effects
  2. contains iodine so will affect the thyroid gland
    • hyperthyroidism can worsen AF
  3. so TFTs must be done regularly
27
Q

Describe how catheter ablation works [3]

A
  1. catheter is inserted into the heart and identifies triggers for paroxysmal AF in the pulmonary veins
  2. once identified, these areas of the myocardium (that are causing the issues) can be either:
    • burnt off by a radiofrequency current or
    • freezed off (called cryo-ablation)
  3. more effective in patients with structurally normal hearts or minimal heart disease
28
Q

If a patient with atrial fibrillation comes in with no or minimal signs for structural heart disease, what are the treatment options? [5]

A
  1. dronedarone
  2. flecainide
  3. propafenone
  4. sotalol
  5. catheter ablation
29
Q

If a patient with atrial fibrillation comes in with coronary artery disease, significant valvular heart disease or abnormal left ventricular hypertrophy, what are the treatment options? [4]

A
  1. dronedarone
  2. sotalol
  3. amiodarone
  4. catheter ablation
30
Q

If a patient with atrial fibrillation comes in with heart failure, what are the treatment options? [2]

A
  1. amiodarone
  2. catheter ablation
31
Q

What are the risks associated with catheter ablation? [2]

A
  1. risk of bleeding into the pericardium
  2. risk that if there’s a thrombosis, the catheter might push it out and send it up to brain → stroke

Week 5 - Cardiology (12 decks)

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