Atrial Fibrillation

Question 1

AF is the most common sustained cardiac arrythmia. T/F?

Answer 1

True

Question 2

What is the major risk with AF?

Answer 2

Stroke

Question 3

What are the possible symptoms of AF?

Answer 3

Palpitations
Dyspnoea
Chest pain
Syncope
Complications such as stroke

Question 4

On examination how is the pulse in a patient with AF classically described?

Answer 4

Irregularly irregular

Question 5

What test is used to confirm an irregularly irregular pulse as AF?

Answer 5

ECG

Question 6

AF can be paroxysmal or persisting. T/F?

Answer 6

True

Question 7

Why might ambulatory ECG be required to diagnose AF?

Answer 7

AF can. be paroxysmal

Question 8

What signs of AF will be seen on ECG?

Answer 8

Irregularly irregular heart rate
Narrow QRS complexes
No P waves

Question 9

‘Saw-tooth’ electrical activity on an ECG is characteristic of…?

Answer 9

Atrial flutter

Question 10

Other than ECG, what tests should be conducted for AF?

Answer 10

TFTs
LFTs
Echocardiogram

Question 11

What conditions can predispose to AF?

Answer 11

Hypertension
Symptomatic heart failure
Valvular heart. disease
Cardiomyopathies
Atrial septal defect / other congenital defect
Coronary artery disease
Thyroid dysfunction
Obesity
Diabetes mellitus
COPD
Sleep apnoea
Chronic renal disease

Question 12

What are the objectives of treatment in AF?

Answer 12

Prevention of stroke
Relief of symptoms
Management of concomitant CVD
Control heart rate
Possibly also control heart rhythm

Question 13

What is the target heart rate for patients with AF?

Answer 13

<110/min

Question 14

If symptomatic, what is the target heart rate for patients with AF?

Answer 14

<80/min

Question 15

What are the major risk. factor for stroke in AF patients?

Answer 15

Previous stroke
TIA or systemic embolism
Age >75 years

Question 16

What are the minor risk. factor for stroke in AF patients?

Answer 16

CHF or moderate to severe LV systolic. dysfunction
Hypertension
Diabetes mellitus
Female. sex
Age 65-74
Vascular disease

Question 17

Risk factors for stroke in AF patients are collated via which scoring system?

Answer 17

CHADS-VAS

Question 18

How are patients with AF treated to. prevent stroke?

Answer 18

Anticoagulation - warfarin or DOACS

Question 19

Which AF patients should be referred for specialist assessment?

Answer 19

Still symptomatic despite adequate rate control
Young age <60
Inadequate rate control despite beta blocker/clacium antagonist and digoxin
Structural heart disease on echo
AF and coexisting herat failure

Question 20

What medications are used for the symptomatic management of AF?

Answer 20

Beta blocker or calcium. antagonist

Digoxin

Question 21

For which AF patients I rhythm control particularly important?

Answer 21

Younger patients

Ongoing symptoms despite good rate control

Question 22

What are the options for rhthym control in AF patients?

Answer 22

Direct current cardioversion
Antiarhthymics
Catheter ablation

Question 23

What potential side effect of amiodarone can, in itself, cause AF?

Answer 23

Thyroid dysfunction

Question 24

What antiarrhthymic drugs can be used to treat AF?

Answer 24

Sodium channel blockers (flecainide, propafenone)
Potassium channel blockers (sotalol, amiodarone)
Multi-channel blockers (dronedarone)

Question 25

What is the most effective management for rhthym control in AF patients with structurally normal hearts or minimal heart disease?

Answer 25

Catheter ablation