Atrial Fibrillation

Question 1

Define Atrial Fibrillation:

Answer 1

Chaotic Irregular atrial rhythm at 300-600bpm, and hence irregular ventricular rate - heart rate is irregularly irregular.

Question 2

Atrial Fibrillation: Causes: 
HA/MI
HF
HT
Thy
A
Pn
C

Answer 2

Atrial Fibrillation: Causes: 
Heart Attack/Myocardial Infarction
Heart Failure
Hypertension
Hyperthyroidism 
Alcohol
Pneumonia 
Caffeine

Question 3

Atrial Fibrillation: Symptoms:
CP
B/D
P
S
A

Answer 3

Atrial Fibrillation: Symptoms:
Chest Pain
Breathlessness/Dyspnoea
Palpitations
Syncope 
Asymptomatic

Question 4

Atrial Fibrillation: Signs:
HS
P
LVF

Answer 4

Atrial Fibrillation: Signs:
First Heart Sound - variable intensity
Pulse - Irregularly Irregular
LVF - Orthopnoea, Fatigue, Paroxysmal Nocturnal Dyspnoea, Cold Peripheries, Weight Loss, Muscle Wasting

Question 5

Atrial Fibrillation: Investigations:
B
E
E
T

Answer 5

Atrial Fibrillation: Investigations:
Blood - FBC, U & E, Cardiac Enzymes, Thyroid Function
ECG - absent P waves, irregular QRS
Echo - LAH, MV disease, poor LV function
The CHA2DS2-VASc Score - to decide Anticoagulation

Question 6

Atrial Fibrillation: Treatment:
Acute:
Chronic: Rate (B/C,D,A), Rhythm (F,C)

Answer 6

Atrial Fibrillation: Treatment:
Acute: < 48 hours, if very ill or haemodynamically unstable give Oxygen, take U&E’s and perform emergency Cardioversion - if unavailable, try IV Amiodarone
Chronic: Rate Control: Beta-Blocker or Calcium Channel Blocker, Digoxin - Na/K Channel blocker (if above doesn’t work)
Chronic Rhythm: Flecainide, Cardioversion

Question 7

Atrial Fibrillation: Other Treatments: 
H
W/ACG
D
PM

Answer 7

Atrial Fibrillation: Other Treatments: 
Heparin
Warfarin/Anticoagulant 
Dabigartan
Pacemaker

Question 8

Atrial Fibrillation: Treatments Exceptions: Stoke/TIA Patient:

Answer 8

Warfarin, or a Direct Thrombin or Factor Xa Inhibitor should be given with another anticoagulant e.g. Apixaban.

Question 9

Atrial Fibrillation: Treatments Exceptions: Stable CVD & amp; AF Patient:

Answer 9

Generally managed on anticoagulant and the antiplatelet is stopped.

Question 10

Atrial Fibrillation: Treatment:
Acute: < 48 hours
1. 2. 3.if

Answer 10

< 48 hours:

1. If very ill or haemodynamically unstable give Oxygen
2. Take U&E’s
3. Emergency Cardioversion
4. If EmCV unavailable, try IV Amiodarone

Question 11

Atrial Fibrillation: Treatment:
Chronic: Rate Control:
1. 2. 3. 4.if

Answer 11

Chronic: Rate Control: one of below
1. Beta-Blocker
2. Calcium Channel Blocker
3. Digoxin - Na/K Channel blocker 
4. (if above doesn't work)
Chronic Rhythm: Flecainide, Cardioversion