Atrial fibrillation and Atrial flutter Flashcards
Atrial fibrillation
-risk of thrombus formation in the…
Left ventricle
Atrial fibrillation
-Risk factors
Modifiable: smoking, alcohol abuse
Non-modifiable: male sex, ethnicity, cardiovascular disease, family history
-hypertension, diabetes, sleep apnea, renal dysfunction, pulmonary disease
Atrial fibrillation
-complications
- stroke or other thromboembolic events,
- death,
- hospitalization,
- quality of life may become impaired, -LV dysfunction (1/3 of the patients) and HF,
- cognitive decline and dementia, depression.
Atrial fibrillation
-pathophysiology
- atrial remodeling due to external stressors
- atria contract rapidly but ineffectively –> stasis of blood within the atria –> risk of thromboembolism and stroke
Atrial fibrillation
-clinical presentation
- asymptomatic or symptomatic –> but both need anticoagulation!
- palpitations, dyspnea, chest discomfort,
- dizziness, syncope, fatigue, polyuria
Atrial fibrillation
-physical examination
- irregular pulse on manual palpitation
- irregular jugular venous pulsations
- variation in first heart sound intensity
- absence of fourth heart sounds
Atrial fibrillation
-diagnostics
- ECG
- transthoracic echocardiography
- Lab: thyroid and kidney function, electrolytes, CBC.
- correct anemia –> anemia patients have poor tolerated Afib
- hyperthyroidism –> sometimes, after you treat it –> it gets better.
Atrial fibrillation
-ECG criteria
- irregular rhythm
- no visible P waves
- no isoelectric baseline
- variable ventricular rate
- narrow QRS
- fibrillatory waves
Atrial fibrillation
-management
Do structural characterization of Afib:
4s - re-check every 4-6 months
- estimate stroke risk
- symptoms severity
- severity of Afib burden
- AF substrate
Atrial fibrillation
-classification
- First diagnosed
- Paroxysmal - self-terminating (usually within 48hrs), some can last up to 1 weeks, including the ones that are cardivoerted
- Persistent - longer than 7 days
- Long-standing persistent - lasting more than 1 year and has decided to be cardioverted
- Permanent - accepted by the patient and doctor, only rate control strategy and anti-coagulation should be adopted.
Atrial fibrillation
-treatment strategy
ABC pathway
A- anticoagulation –> avoid stroke
B - better symptoms management
C - cardiovascular and comorbidity optimization
Atrial fibrillation
-treatment strategy - A
- Evaluate CHA2DS2-VASc score and then decide about anticoagulation
- Aspirin –> anti-aggregate, not an anti-coagulant! Do not use in AF patients
Atrial fibrillation
-treatment strategy - B
Rate control - first choice: beta blockers. Last choice is Amiodarone due to very high organ toxicity.
-Target <110bpm at rest
Rhythm control - only for symptomatic patients
-Cardioversion: evaluate risk of thromboembolic events before doing it!
Atrial fibrillation
-Cardioversion
- low risk of stroke –> perform without pre-treatment
- high risk of stroke –> anti-thrombotic therapy 3 weeks before cardioversion
- after cardioversion is done –> 4 weeks of anticoagulants
- Pharmacological cardioversion: propafenone, amiodarone, flecainide.
Atrial fibrillation
-treatment for permanent AF
- Digoxin monotherapy –> only for older, sedentary patients
- First choice: beta blockers
