Atrial Fibrillation

Question 1

Define atrial fibrillation.

Answer 1

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia. It is characterised by uncoordinated atrial activity on the surface ECG, with fibrillatory waves of varying shapes, amplitudes, and timing associated with an irregularly irregular ventricular response when atrioventricular (AV) conduction is intact.

Question 2

Explain the aetiology/risk factors of atrial fibrillation.

Answer 2

Coronary artery disease (CAD), hypertension, heart failure, valvular disease, diabetes, thyroid disorders, COPD and obstructive sleep apnoea, and advanced age are known risk factors for the development of new-onset AF.

Heavy alcohol intake can also increase the risk of atrial fibrillation.

Question 3

Summarise the epidemiology of atrial fibrillation.

Answer 3

The incidence of AF increases progressively with age.
Incidence is higher in men but mortality is higher in women.

Question 4

Recognise the presenting symptoms of atrial fibrillation.

Answer 4

SOB
Palpitations
Chest tightness

Question 5

Recognise the signs of atrial fibrillation on physical examination.

Answer 5

Hypotension
Elevated jugular venous pressure
Added heart sounds

Question 6

Identify appropriate investigations for atrial fibrillation and interpret the results.

Answer 6

ECG
Serum electrolytes
Cardiac biomarkers
Thyroid function tests
CXR
Transthoracic echocardiogram
Transoesophageal echocardiogram (TOE)

Question 7

Generate a management plan for atrial fibrillation.

Answer 7

The 3 elements in the management of new-onset AF are:

Ventricular rate control
Restoration and maintenance of sinus rhythm
Prevention of thromboembolic events.

Question 8

Identify the possible complications of atrial fibrillation and its management.

Answer 8

Acute stroke
MI
Congestive heart failure

Question 9

Summarise the prognosis for patients with atrial fibrillation.

Answer 9

The prognosis depends on the onset, age and lifestyle of the patient.