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Cardiovascular > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

Define Atrial Fibrillation?

A

Characterised by rapid, chaotic and ineffective atrial electrical conduction

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2
Q

How is Atrial Fibrillation often subdivided?

A

Permanent
Persistent
Paroxysmal

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3
Q

What is the aetiology of Atrial Fibrillation?

A

There may be no identifiable cause

Secondary Causes lead to an abnormal atrial electrical pathway that results in AF

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4
Q

What are the systemic causes of Atrial Fibrillation?

A

Thyrotoxicosis
Hypertension
Pneumonia
Alcohol

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5
Q

What are the cardiac causes of Atrial Fibrillation?

A 
Mitral valve disease 
Ischaemic Heart Disease 
Rheumatic Heart Disease 
Cardiomyography
Pericarditis 
Sick sinus syndrome
Atrial myxoma
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6
Q

What are the lung causes of Atrial Fibrillation?

A

Bronchial Carcinoma

PE

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7
Q

What is the epidemiology of Atrial Fibrillation?

A

Very common in the elderly
Present in 5% of those >65 years
May be paroxysmal

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8
Q

What are the presenting symptoms of Atrial Fibrillation?

A

Often Asymptomatic
Palpitations
Syncope (if low output)
Symptoms of the cause of AF

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9
Q

What are the signs of Atrial Fibrillation on physical examination?

A

Irregularly irregular pulse
Difference in apical beat and radial pulse
Check for signs of thyroid disease and valvular disease

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10
Q

What would you see on an ECG for Atrial Fibrillation?

A

Uneven baseline with absent P waves
Irregular intervals between QRS complexes
Atrial Flutter = saw-tooth

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11
Q

What bloods would you do for Atrial Fibrillation?

A 
Cardiac Enzymes 
TFT 
Lipid Profiles 
U&Es
Mg2+
Ca2+
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12
Q

Why do we do U&Es, Mg2+ and Ca2+?

A

There is an increased risk of digoxin toxicity with hypokalaemia, hypomagnesaemia and hypercalcaemia

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13
Q

What might we see on an Echocardiogram in Atrial Fibrillation?

A

Mitral Valve disease
Left atrial dilation
Left Ventricular dysfunction
Structural Abnormalities

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14
Q

What do we do first when managing Atrial Fibrillation?

A

Try to treat any reversible causes (e.g. thyrotoxicosis, chest infection)

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15
Q

What are the two main components to AF management?

A

Rhythm Control

Rate Control

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16
Q

What do we do in Rhythm Control if it is > 48 hrs since onset of Atrial Fibrillation?

A

Anticoagulate for 3-4 weeks before attempting cardioversion

17
Q

What do we do in Rhythm Control if it is < 48 hrs since onset of Atrial Fibrillation?

A 
DC cardioversion (2 x 100 J, 1 x 200 J)
Chemical cardioversion: flecainide or amiodarone
18
Q

When is flecainide contraindicated?

A

If there is a history of Ischaemic Heart Disease

19
Q

What’s the other step we do to control rhythm?

A

Prophylaxis against Atrial Fibrillation

20
Q

What’s involved in Prophylaxis against Atrial Fibrillation?

A

Sotanol
Amiodarone
Flecainide
Consider pill-in-the-pocket (single dose of a cardioverting drug (e.g. flecainide) for patients with paroxysmal AF) strategy for suitable patients

21
Q

What do we do to control rate in chronic AF?

A

Control ventricular rate with:
Digoxin
Veraparmil
Beta-Blockers

22
Q

What ventricular rate do we aim for in AF management?

A

90 bpm

23
Q

How do we stratify the risk of stroke in patients with Atrial Fibrillation?

A

CHADS-Vasc Score

24
Q

What risk factors are included in the CHADS-Vasc Score?

A 
Previous thromboembolic event 
Age > 75 years 
Hypertension
Diabetes 
Vascular disease
Valvular disease 
Heart Failure 
Impaired left ventricular function
25
Q

How do we manage patients with a low risk of stroke?

A

Aspirin

26
Q

What do we do to patients with a high risk of stroke?

A

Require anticoagulation with warfarin

27
Q

What are the possible complications of Atrial Fibrillation?

A

Thromboembolism

Worsening of existing heart failure

28
Q

What are the characteristics of Thromboembolism?

A

Embolic stroke risk of 4% per year

Risk is increased with left atrial enlargement or left ventricular dysfunction

29
Q

What is the prognosis for patients with Atrial Fibrillation?

A

Chronic AF in a disease heart doesn’t usually return to sinus rhythm

Cardiovascular (34 decks)

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