Atrial Fibrillation Flashcards
What are the two causes for an irregularly irregular pulse and how can they be differentiated? (3)
Atrial fibrillation
Ventricular ectopics
Can be differentiated using an ECG
What are the features of AF on an ECG? (3)
Absent P waves
Narrow QRS complex tachycardia
Irregularly irregular ventricular rhythm
What are the most common causes of AF?
SMITH
S- Sepsis M- Mitral valve pathology (stenosis/regurgitation) I- Ischaemic heart disease T- Thyrotoxicosis H- Hypertension
What are the exemptions to someone being rate controlled for their AF?
There is a reversible cause
Their AF is of new onset (last 48 hrs)
Their AF is causing HF
They remain symptomatic despite being rate controlled
What are the 3 drug options for rate controlling AF?
Beta blocker (first line)
Calcium channel blocker (not preferable in HF patients)
Digoxin (only in sedentary patients, drug needs monitoring as risk of toxicity)
What are the criteria for offering someone rhythm control for their AF?
There is a reversible cause of their AF
Their AF is of new onset (under 48 hrs)
Their AF is causing HF
They remain symptomatic even after rate control
What is first line medications for immediate rhythm control in AF?
Flecanide
Amioderone (drug of choice for patients with structural heart disease)
What are the long term medications for rhythm control of AF?
Beta blockers (first line)
Dronedarone (second line after successful initial rhythm control)
Amioderone for patients with left ventricular dysfunction
What is the drug of choice for people with paroxysmal AF (infrequent episodes lasting no more than 48 hrs)
Flecanide
When deciding to anticoagulate AF patients, the CHA2DS2VASc score is used, what does it stand for?
C- Congestive HF H- Hypertension A2- Age over 75 (scores 2) D- Diabetes S2- Previous stroke or TIA (scores 2) V- Vascular disease A- Age 65-75 S- Sex (female)
What are the three thresholds of scores for chadsvasc and what do they represent?
0: don’t give anticoagulant
1: Consider anticoagulant in men, give to women
Over 1: Give anticoagulant
What is HASBLED used for and what does it stand for?
Risk of patient bleeding on anticoagulant
H- Hypertension A- Abnormal renal and liver function S- Stroke B- Bleeding L- Labile INR’s (whilst on warfarin) E- Elderly D- Drugs or alcohol
What is the target INR for AF?
2-3
Target is 2.5
What are the benefits of DOAC’s over Warfarin?
No monitoring required
No major drug interactions
Equal or slightly better than warfarin at preventing strokes in AF
Equal or slightly less bleeding risk than warfarin
