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Clinical Physiology > Atrial Fibrillation and Heart Failure > Flashcards

Atrial Fibrillation and Heart Failure Flashcards

1
Q

What is the coagulation cascade?

A

extrinsic pathway
intrinsic pathway
common pathway

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2
Q

What is the extrinsic pathway?

A

it is activated when there is external injury that results in blood loss to the vascular system.

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3
Q

What is the intrinsic pathway?

A

it is activated when there is internal injury within the vascular system.

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4
Q

What is the common pathway?

A

this is where the extrinsic and intrinsic pathway meet to form a clot

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5
Q

What is PT/INR and what does it measure?

A

prothrombin time and international normalised ratio.
INR calculated from PT level - used to measure in patients taking warfarin
measures extrinsic and common pathways

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6
Q

What clotting factors does PT/INR assess?

A

I, II, V, X (clotting factors of the common pathways), and factor VII (clotting factor of the extrinsic pathway)

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7
Q

What does the PT/INR tell us?

A

how fast prothrombin turns into thrombin

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8
Q

What does a high PT time indicate?

A

High results mean the patient has a prolonged time forming a clot:
clotting disorders, vitamin k deficiency, types of cancers, liver disease, or the patient is taking an anticoagulant

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9
Q

What is aPTT?

A

activated partial thromboplastin time
assesses intrinsic and common pathways

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10
Q

What clotting factors does aPTT assess?

A

clotting factors: I, II, V, X (clotting factors of the common pathways), and XII, XI, IX, VIII (clotting factors of the intrinsic pathway)
prekallikrein, high molecular weight kallikrein

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11
Q

Differential diagnosis of a chesty cough?

A

viral infection, pneumonia, COPD

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12
Q

Differential diagnosis of heart racing?

A

anxiety, dysrhythmia (atrial fibrillation, superventricular tachycardia)

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13
Q

Recommended alchohol intake?

A

<10 units a week

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14
Q

ECG indications for atrial fibrillation?

A

absent P wave
irregular RR interval

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15
Q

What is atrial fibrillation?

A

most common atrial tachyarrhythmia.
It is caused by abnormal and irregular heart rhythm in which electrical signals are generated chaotically throughout the upper chambers (atria) of the heart.

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16
Q

Which is more concerning - AF or VF?

A

Ventricular arrhythmia is more concerning - life threatening. Very strictly managed in hospital setting. AF can be managed in a community setting.

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17
Q

Symptoms of AF?

A
  • Your heart rate is usually a lot faster than normal.
  • Your heartbeat is irregular - that is, an abnormal heart rhythm (an arrhythmia).
  • The force of each heartbeat can vary in intensity. AF can be asymptomatic.

Common symptoms includes; palpitation, chest discomfort, dizziness, syncope, shortness of breath, lethargy.

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18
Q

Cardiac causes of AF?

A
  • ischaemic heart disease
  • rheumatic heart disease
  • hypertension
  • sick sinus syndrome
  • pre-excitation syndromes

less common:
- cardiomyopathy
- pericardial disease
- atrial septal defect
- atrial myxoma

19
Q

Non cardiac causes of AF?

A
  • acute infection (e.g., pneumonia)
  • electrolyte depletion
  • lung carcinoma
  • intrathoracic pathology e.g, pleural effusion
  • pulmonary embolism
  • thyrotoxicosis
20
Q

Management of AF

A
  • Rate control using beta blocker or calcium channel blocker
  • Rhythm control using electrical and/or pharmacological approach or ablation
  • Stroke Prevention
  • Treating underlying cause
21
Q

Most common complication of AF?

A

stroke

22
Q

Why does AF cause stroke risk?

A

AF causes blood to stagnate in the atria because it is only partially ejected (trying to beat 5x a second). Stagnation causes clotting which when the heart properly beats can go off into the bloodstream.

23
Q

How can stroke be prevented in AF?

A

anticoagulant e.g. warfarin

left atrial appendage occlusion device implanted surgically in patients who can’t take anticoagulants.

24
Q

What is thrombosis?

A

Thrombosis is the formation of potentially deadly blood clots that blocks blood supply.

25
Q

Types of arterial clots and conditions from this?

A
  • Stroke (>24 hr symtoms) and TIA (mini stroke symptoms <24hrs)
  • Myocardial infarction
  • peripheral arterial clot - gangrene
26
Q

Types of venous clots and conditions from this?

A
  • pulmonary embolism
  • deep vein thrombosis
27
Q

What is Virchows triad?

A

3 main factors which can lead to clot formation
SHE
stasis of venous circulation
hypercoagulability
endothelial damage

28
Q

Causes of the three factors of virchows triad?

A

stasis: immobility, varicose veins, heart failure..
hypercoagulability: cancer, sepsis, HRT etc. can be acquired or hereditary reasons
- primary polycytemia - RBC malignancy, genetic component JAK 2 mutations
- secondary polycytemia - can be caused by high altitudes, oxygen sats in blood are low

endothelial damage: surgery, trauma, PICC lines
endothelial dysfunction: smoking, hypertension

29
Q

Why does endothelium damage cause clots?

A

Von willebrand factor released - platelets stick to it and release more factors leading to clot formation

30
Q

How does warfarin work?

A

acts to inhibit vitamin K cycle and vitamin K dependent clotting factors in liver
works on factors X and II

31
Q

Factor Xa inhibitors

A

rivaroxaban
apixaban

32
Q

Factors IIa inhibitors

A

dabigatran

33
Q

Stroke risk assessment

A

CHADVASC
congestive heart failure
hypertension
age >75
diabetes mellitus
stroke/TE
vascular disease
age 65-74
sex

34
Q

Bleeding risk assessment

A

HAS-BLED
hypertension
abnormal renal/liver function
smoke
bleeding
labile inr
elderly
drugs/alcohol

35
Q

Which patients can factor 10a inhibitors not be given in and what should be given instead?

A

patients with metallic heart valves
warfarin

36
Q

Heart Failure

A

inability of the heart to pump blood around the body

37
Q

Causes of heart failure

A
  • Coronary Artery Disease
  • Hypertension
  • Valvular Heart Disease
  • Alcoholism
  • Viral Infection
  • Diabetes
  • Congenital Heart Disease
  • Others: Obesity, Obstructive Sleep Apnea, Smoking, Idiopathic
38
Q

ejection fraction

A

stroke volume/ end diastolic volume

39
Q

Echocardiogram

A

checks how heart’s chambers and valves are pumping blood through the heartq

40
Q

diastolic dysfunction occurs when ….

A

heart fills to much

41
Q

class 1 HF

A

Cardiac disease, but no symptoms and no limitation in ordinary physical activity, e.g. no shortness of breath when walking, climbing stairs etc.

42
Q

class 2 HF

A

Mild symptoms (mild shortness of breath and/or angina) and slight limitation during ordinary activity.

43
Q

class 3 HF

A

Marked limitation in activity due to symptoms, even during less- than-ordinary activity, e.g. walking short distances (20–100 m).
Comfortable only at rest.

44
Q

class 4 HF

A

Severe limitations. Experiences symptoms even while at rest.
Mostly bedbound patients.

Clinical Physiology (11 decks)

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