Atrial Fibrillation (AF)

Question 1

Types?

Answer 1

First detected episode
Paraoxysmal (episodes terminate spontaneously)
Persistant or permanent (not self-terminating)

Question 2

Symptoms/Signs?

Answer 2

Symptoms
¥ palpitations
¥ dyspnoea
¥ chest pain

Signs
¥ an irregularly irregular pulse

Question 3

Investigations?

Answer 3

ECG

Question 4

What are the two key parts of managing patients with AF?

Answer 4

Rate/rhythm control

Reducing stroke risk

Question 5

Rate control medication?

Answer 5

Beta blockers or calcium channel blocker (e.g. diltiazem)

Question 6

If one rate control drug is not sufficient what other can be used? (However only two drug in combination)

Answer 6

Digoxin

Question 7

Agents used to maintain sinus rhythm in patients with a history of atrial fibrillation?

Answer 7

Sotalol
amiodarone
flecainide

Question 8

What is the screening tool to reduce stroke risk?

Answer 8

CHA2D S2VS score

Question 9

What does CHA2D S2VS stand for?

Answer 9

C - Congestive Heart Failure = 1 point
H - Hypertension (treated hypertension) = 1 point
A2 - Age >= 75 yrs ( =2 points)
        Age 65-74 (= 1 point)
D - Diabetes = 1 point

S2 - Prior STROKE or TIA = 2 points
V - Vascular disease (inc. IHD & PVD) = 1 point
S - Sex (female) = 1 point

Question 10

Mx of a score of 0?

Answer 10

No Rx

Question 11

Mx of a score of 1 for males/females?

Answer 11

Males: Consider anticoagulation
Females: No Rx

Question 12

Mx of a score 2 or more?

Answer 12

Offer anticoagulation

NICE recommends: warfarin & novel oral anticoagulants (NOACs)