atrial fibrillation

Question 1

what form occurs in younger patients

Answer 1

paroxysmal

Question 2

causes

Answer 2

conditions resulting in:

• raised atrial pressure
• increased atrial muscle mass
• atrial fibrosis
• inflammation
• infiltration of atrium

Question 3

classic causes

Answer 3

• alcohol
• thyrotoxicosis
• hypertension
• heart failure
• hyperthyroidism

Question 4

what test is mandatory in patients with AF

Answer 4

thyroid function test

Question 5

what chromosomes are associated with familiar atrial fibrillation

Answer 5

10
6
5
4

Question 6

what is atrial fibrillation maintained by

Answer 6

continuous rapid activation of atria by multiple meandering re-entry wavelets.

Question 7

symptoms

Answer 7

• palpitations
• dyspnoea
• chest pain
• decrease exercise capacity
• irregular irregular pulse

Question 8

ECG findings

Answer 8

oscillations of baseline

• no p waves
• rapid QRS rhythm that is irregular

Question 9

acute management

Answer 9

• rate control

- cardioversion

Question 10

how is cardioversion done

Answer 10

electrically by DC shock

or

medically by intravenous infusion

Question 11

how is most conversion to sinus rhythm done

Answer 11

electrical DC cardioversion

Question 12

how to minimise risk of thromboembolism associated with cardioversion

Answer 12

anti-coagulate with warfarin or dabigatran

Question 13

what is done if patient has to have urgent cardioversion not prevent atrial thrombus

Answer 13

transoesophageal echocardiography is used

Question 14

what are the two long term management

Answer 14

• rate control

- rhythm control

Question 15

who is rhythm control mostly for

Answer 15

younger, symptomatic and physically active

Question 16

what are patients with no significant heart disease treated with

Answer 16

class Ia, Ic or III anti arrhythmic drug

don’t use amiodarone until other drug failed

Question 17

what is given to patients who also have heart failure or LVH

Answer 17

amiodarone

Question 18

what is given to patients with coronary artery disease

Answer 18

sotalol or amiodarone

Question 19

who is rate control given to

Answer 19

• permanent form of arrhythmia associated with symptoms
• older than 65 with recurrent atrial tachyarrhythmias
• have failed cardioversion

Question 20

how is rate control achieved

Answer 20

combination of:

• digoxin
• beta blockers
• rate limiting calcium channel (verapamil, diltiazem)

Question 21

when is digoxin monotherapy sufficient

Answer 21

elderly, non-ambualnt patients

Question 22

how to assess adequacy of rate control

Answer 22

ECG - elders

ambulatory 24-monitoring and exercise stress - younger patients

Question 23

when is anticoagulation indicated

Answer 23

patients with AF related to rheumatic mitral stenosis

or

presence of mechanical prosthetic valve

Question 24

what scoring system is used in patients with non-valvular atrial fibrillation to determine need for anticoagulation

Answer 24

CHA2 DS2 VASc

Sc = sex category (female)

Question 25

using CHA2 DS2 VASc when is anticoagulation given

Answer 25

1 = anticoagulant or aspirin

2+ = oral anticoagulant

Question 26

what anticoagulant is given if patient has valvular atrial fibrillation

Answer 26

vitamin K antagonist

Question 27

what anticoagulant is given when patient <65 year and lone AF

Answer 27

no antithrombotic therapy

Question 28

what anticoagulant therapy is given for a CHA2 DS2 VASc of 0

Answer 28

no antithrombotic therapy

Question 29

what anticoagulant is given for a CHA2 DS2 VASc of >1

Answer 29

oral anticoagulant therapy

assess bleeding risk (HAS-BLED score)

Question 30

what is given when anticoagulation is required

Answer 30

warfarin or NOAC

NOAC = dabigatran and rivaroxaban

Question 31

how to NOAC work

Answer 31

block a single step in coagulation cascade