Atrial fibrillation Flashcards
define atrial fibrillation?
cardiac arrhythmia characterised by rapid, chaotic and ineffective atrial electrical conduction. Often subdivided into
o Permanent - continuous AF that cannot be cardioverted.
o Persistent when episodes of AF are not self-terminating lasting more than 7 days
o Paroxysmal when episodes of AF terminate lasting less than 7 days
systemic causes of AF?
o Thyrotoxicosis
o Hypertension
o Pneumonia
o Alcohol
heart causes of AF?
o Mitral valve disease o Ischaemic heart disease o Rheumatic heart disease o Cardiomyopathy o Pericarditis o Sick sinus syndrome o Atrial myxoma
lung causes of AF?
o Bronchial carcinoma
o PE
what is the epidemiology of atrial fibrillation?
• VERY COMMON in the elderly
presenting symptoms of AF?
- Often ASYMPTOMATIC
- Palpitations
- Dyspnoea
- Chest pain
- Syncope
what are the signs of AF on physical examination?
- Irregularly irregular pulse
* Difference in apical beat and radial pulse
first line investigation for AF with results?
• ECG - will be irregularly irregular
what might the bloods show for AF?
o Cardiac enzymes
o TFT
o Lipid profile
o U&Es, Mg2+ and Ca2+
what might an echo show in AF?
- Mitral valve disease
- Left atrial dilatation
- Left ventricular dysfunction
- Structural abnormalities
what are the three main aspects of management in AF?
- RATE CONTROL
- RHYTHM CONTROL
- STROKE RISK prevention
how can rate be controlled?
- Beta blockers (NOT FOR ASTHMA)
- CCBs
- Digoxin (preferred if patient has heart failure)
how can the rhythm be controlled?
- DC cardioversion
- Amiodarone
- Flecainide
- Consider pill-in-the-pocket
how can AF patients be managed for stroke risk?
o LOW RISK patients can be managed with aspirin
o HIGH RISK patients require anticoagulation with warfarin
what is the chad vase score?
Stroke 2
Age>75 2
Diabetes 1
Congestive heart failure 1 Hypertension 1 Age 65-74 1 Vascular disease 1 Sex (female =1)
