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arrhythmias > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

How is AF characterised?

A

rapid, chaotic, uncoordinated and ineffective atrial activation

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2
Q

What is the atrial rate?

A

400-600 bpm

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3
Q

What is the ventricular rate?

A

80-180 bpm

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4
Q

What diseases is AF common in?

A 
CHD
hyperthyroidism
rheumatic heard disease
mitral valve disease
CHF
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5
Q

Presentations of AF

A 
irregular pulse
ECG changes
palpitations
dyspnoea (SOB)
fatigue
tight chest/pain
dizziness, light-headed, syncope
disordered sleep
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6
Q

What ECG changes occur?

A

irregular R-R interval
elevated HR
absence/loss of P waves
F waves (fibrillatory) - irregular atrial activations/chaotic isoelectric line

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7
Q

What are the 5 classifications of AF?

A 
1 first detected or diagnosed AF
2 paroxysmal AF
3 persistent AF
4 long-standing persistent AF
5 permanent AF
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8
Q

What is first detected/diagnosed AF?

A

first clinical presentation
patient still in AF
independent of duration and other symptoms

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9
Q

Paroxysmal AF?

A

recurrent
self-terminating episodes
lasting less then 7 days

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10
Q

Persistent AF?

A

episodes lasting longer then 7 days

need termination by pharmacological or electrical cardioversion

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11
Q

Long standing persistent AF?

A

episodes lasting longer then 1 year when decision made for rhythm control

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12
Q

Permanent AF?

A

episodes lasting more then 1 year
decision not to pursue restoration of sinus rhythm
accepted

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13
Q

Underlying mechanisms of AF?

A

enhanced automaticity
multiple re-entrant circuits
atrial remodeling

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14
Q

What type of remodeling occurs?

A

electrical
cellular
structural
neurohormonal

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15
Q

What does remodeling lead to?

A

initiation, progression and maintenance of AF

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16
Q

Where is a common site of clot formation?

A

left atrial appendage

17
Q

How can AF cause stroke?

A

blood pools in atria
blood clot forms
whole/part of the clot breaks off
blood clot travels to brain and blocks cerebral artery causing stroke

18
Q

4 parts of treatment approach

A

control ventricular rate - rate control
control sinus rhythm - rhythm control
prevent recurrent episodes
prevent stroke (thromboembolism)

19
Q

What does thromboprophylaxis mean?

A

prevention of thromboembolic consequences (stroke)

20
Q

How to assess stroke risk?

A

CHA2DS2 VASc

21
Q

How to assess bleeding risk?

A

HAS BLED

22
Q

What therapy is given for stroke prevention?

A

anticoagulant

23
Q

2 types of anticoagulants that can be given

A

vitamin K antagonist OACs - warfarin

novel, new or non-vit K antagonists OACs (NOACs)

24
Q

2 types of NOACs

A

direct thrombin inhibitor - dabigatran

direct factor Xa inhibitor - rivaroxaban, apixaban, edoxaban

25
Q

How to restore sinus rhythm?

A

electrical cardioversion - DC cardioversion

pharmacological cardioversion - amiodarone, flecainide, propafenone

26
Q

When is electrical cardioversion used?

A

if there’s hemodynamic instability

27
Q

When is amiodarone given?

A

no hemodynamic instability

but structural heard disease

28
Q

Pharmacological therapy for rhythm control

A

beta blocker
amiodarone, dronedarone
flecainide, propafenone

29
Q

non-pharmacological therapy for rhythm control

A 
left atrial catheter ablation ( radiofrequency/cryoenergy to isolate vein/foci)
surgical ablation (COX-Maze procedure)
30
Q

What is rate control used for?

A

control or slow the fast ventricular response via AV blockade

31
Q

What is rate control used for in paroxysmal and persistent AF?

A

control of ventricular rate

32
Q

What is rate control used for in permanent AF?

A

long term rate control

33
Q

What pharmacological therapy is used for rhythm control?

A 
beta blockers (not sotalol)
Ca channel blocker (diltiazem, verapamil)
digoxin
34
Q

Non-pharmacological therapy in rate control

A

AV node ablation with pacing

arrhythmias (1 decks)

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