Atrial Fibrillation

Question 1

hallmark of AF

Answer 1

irregularly irregular pulse

absent P waves on ECG

Question 2

differential for an irregularly irregular pulse

Answer 2

ventricular ectopics

Question 3

symptoms of AF

Answer 3

usually asymptomatic

symptoms can include

• palpitations
• SOB
• syncope
• complications e.g. stroke

Question 4

underlying causes of AF

Answer 4

Sepsis

Mitral valve stenosis

Ischaemic heart disease

Thyrotoxicosis

HTN

Question 5

How can AF be classified

Answer 5

first detected episode

paroxysmal

persistent

permanent

Question 6

what is paroxysmal AF

Answer 6

AF that self terminates episodes last <7 days (typically less than 24 hours)

Question 7

what is persistent AF

Answer 7

AF that does not self terminate - requires cardio version episodes last > 7 days

Question 8

what is permanent AF

Answer 8

AF that cannot be cardioverted - goal is rate control + decrease stroke risk

Question 9

1st line rate control in patients with no contraindications

Answer 9

beta blocker e.g. atenolol

Question 10

contraindication to atenolol

Answer 10

asthma

Question 11

2nd line options for rate control

Answer 11

diltiazem - rate limiting ca channel blocker (avoid in HF)

digoxin - good in HF

Question 12

what patients would be suitable for rhythm control

Answer 12

episode of AF < 48 hours

reversible cause of their AF

AF is causing HF

symptomatic

Question 13

two methods of cardioversion

Answer 13

pharmacological e.g. flecanide / amiodarone

electrical - DC cardioversion

Question 14

amiodarone is used for cardioversion in which patients

Answer 14

patients with structural heart disease

Question 15

what patients are suitable for immediate cardioversion

Answer 15

AF present for < 48 hours

haemodynamically unstable

Question 16

what patients receive delayed cardioversion

Answer 16

AF present > 48 hours

stable

Question 17

what is required before delayed cardioversion

Answer 17

3 weeks anticoagulation

Question 18

score used to calculate anticocoagulation requirement in AF patients

Answer 18

CHA₂DS₂-VAS_C

Question 19

what does CHA₂DS₂-VAS_c stand for

Answer 19

Congestive HF = 1 point

HTN = 1 point

Age₂ > 75 = 2 points

Diabetes = 1 point

Stroke / Tia previously = 2 points

Vascular disease = 1 point

Age 65-74 = 1 point

Sex (female) = 1 point

Question 20

what CHA₂DS₂-VAS_C score should be offered anticoagulation

Answer 20

>1

Question 21

anticoagulation options for AF

Answer 21

Warfarin - vitamin K antagonist (Aim for INR 2-3)

Rivaroxaban / Apixaban - factor Xa inhibitors