Atrial Fibrillation And Anticoagulation Flashcards
What is the most likely cause of acute AF in a 35 year old female?
Alcohol excess
What is the most appropriate initial management in a 35F presenting with new onset acute AF? With and without haemodynamic stability
If unstable - emergency DC cardioversion
If stable - pharamcological cardioversion
What is the management choice for new onset AF that has been going for longer than 48 hours
Rate control - BB, CCB or digoxin, 1 or 2 of them
What are some pharmacological cardioversion drug options
Amiodarone or flecainide.
When to choose amiodarone or fleicainide?
Fleicainide works better within 12 hours of new onset acute AF, but has increased risk of MI in someone with structural heart abnormalities.
Amiodarone otherwise.
What is the most common acute adverse effect with the use of amiodarone?
Thrombophlebitis
If someone with a history of AF presents with paraoxysmal AF, what are the management options?
Assess need for long term rhythm control, or pill in pocket option
What are some examples of warfarin inducers
Alcohol
Carbamazepine
Rifampicin
St john’s worts
What are some examples of warfarin inhibitors
Erythromycin Grape fruit juice Amiodarone Simvastatin SSRI Tramadol
Chronic Side effects of amiodarone?
Pulmonary fibrosis
Thyroid dysfunction
Photosensitivity
What kind of CCB can be used for rate control in AF?
Diltiazem or verapamil, has to inhibit L type Ca channel
Adverse effects of diltiazem
Headache
Hypotension
Ankle edema
Constipation
How does digoxin work when used for AF?
Increases vagal tone - slows heart, antiarrythmic effect
Inhibits k+/na channel, increases intracellular calcium, positive inotropic effect
How is digoxin excreted?
Renally
Adverse effects of beta blockerts?
Bronchospasm
Negative inotropy and chronotropy
