Atrial FIbrillation Flashcards
atrial contraction in AF
uncoordinated, rapid and irregular
p waves on ECG
absent
complications
tachycardia
heart failure
risk of embolic stroke
presenting symptoms
often incidental
palpitations, SOB, syncope
2 differentials for irregularly irregular pulse
AF
ventricular ectopics
AF on an ECG
absent p waves
narrow QRS
irregularly irregular ventricular rhythm
valvular AF
AF with mitral stenosis or mechanical heart valve
most common causes of AF - SMITH
sepsis mitral valve pathology IHD thyrotoxicosis hypertension
2 principles for treatment
rate or rhythm control
anticoagulation
rate control
beta blocker - atenolol 10-100mg
CCB
digoxin
rhythm control
cardioversion
immediate vs delayed cardioversion
immediate if present less than 48hrs or haemodynamically unstable
delayed cardioversion and anticoagulation
3 weeks prior
mobilising clot and causing stroke
pharmacological cardioversion
Flecanide
Amiodarone
electrical cardioversion
sedation and cardiac defibrillator
long term medical rhythm control
beta blockers
amiodarone - left heart failure
pill in the pocket treatment
flecanide
where is blood common to become stagnated?
atrial appendage
chadsvasc
whether somone with AF should start on anticoagulation
HAS-BLED
anticoagulation risk of bleeding
what does warfarin do to prothrombin time?
prolong it
What is the INR?
prothrombin time compared to normal adult
2 - twice as long to clot
what enzyme affects warfarin?
liver enzyme cytochrome p450
what can affect enzyme levels?
antibiotics
leafy green veg, cranberry juice and alcohol
on warfarin and bleeding?
vitamin K injection
advantages of DOACs over warfarin
no monitoring
no major interactions
equal preventing stroke
equal or less chance of bleeding
what does chads2vasc stand for?
congestive heart failure hypertension age >75 (2 points) diabetes stroke (2 points) vascular disease age 65-74 sex
