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Year 3 Cardiology > Atrial fibrillation + arrhythmias > Flashcards

Atrial fibrillation + arrhythmias Flashcards

1
Q

Pathophysiology of AF

A

Impaired electrical heart activity causing an irregularly irregular rhythm

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2
Q

Risk factors for AF

A
  • hypertension
  • Coronary heart disease
  • mitral stenosis
  • pericarditis
  • pneumonia
  • Hyperthyroidism
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3
Q

Presentation

A

Symptoms:

  • palpitations
  • dizziness
  • syncope
  • dyspnoea

Signs:

  • tachycardia
  • irregularly irregular pulse
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4
Q

Investigations

A
  • cardiac examinations
  • basic obs
  • ECG
  • Bloods - FBC, U+Es, TFTs, Trop I
  • CXR - for underlying cause such as pneumonia
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5
Q

ECG changes

A
  • absent P waves
  • wavy baseline
  • irregular QRS complexes
  • irregularly irregular tachycardia
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6
Q

Management rhythm control

A
  • if haemodynamically unstable - DC cardioversion
  • if haemodynamically stable - check time of onset

Within 48 hrs:

  • DC cardioversion
  • or chemical cardioversion

Longer than 48hrs:

  • anticoagulation with warfarin
  • for 3 - 4 weeks
  • cardioversion after
  • or TOE to rule out clots
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7
Q

Chemical cardioversion

A

Flecainide - contraindicated in IHD

Amiodarone - 1st line in AF with HF

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8
Q

Rate control

A
  • diltiazem CCB
  • beta blocker
  • digoxin

If one drug does not help, can use a combination of 2

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9
Q

CHADSVAS score management

A

Stroke risk stratification:
- low risk - 0 in males and 1 in females - no treatment

  • medium - 1 in males and 2 in females - consider treatment
  • high risk - 2+ in males and 3+ in females - warfarin
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10
Q

CHADSVASC scoring

A 
Congestive HF - 1 
HTN - 1 
Age 75+ - 2
DM - 1
Stroke/TIA - 2 
Vascular disease - 1 
Age - 65 - 74 - 1
Sex = Female - 1

Max score = 9

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11
Q

SVT

A

Problem with SAN, AVN or atrium
High HR
Anomaly with P waves or PR interval
Normal QRS

Narrow complex tachycardia - SVT

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12
Q

VT

A

Problem with ventricles, Bundle of His or Perkinje fibres
High HR due to ventricle pathology
Normal P waves
Broad QRS

Broad complex tachycardia - VT

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13
Q

Indication for electrical DC cardioversion

A

Persistent AF for more than 48 hours

Haemodynamically unstable

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14
Q

Commonest causes of AF

A

IHD
Hyperthyroidism
Hypertension

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15
Q

Wolff Parkinson White syndrome cause, ECG changes and symptoms

A

Accessory pathway causing inappropriate pathway of conduction

  • palpitations
  • delta wave and short PR interval on ECG
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16
Q

Atrial flutter pathophysiology

A

APs continually travelling around right atrium dependent on tissue from IVC and tricuspid valve

17
Q

Atrial flutter signs on ECG

A

2:1 P wave: QRS

Saw tooth appearance

18
Q

LBBB

A

Broad QRS - more than 3 small squares
Negative QRS complex in leads V1 - V4
Positive QRS in V6
Left axis deviation

19
Q

RBBB

A

Broad QRS - more than 3 small squares
V1 has bunny ear positive QRS appearance
Slurred S wave in V6

20
Q

How to calculate HR from ECG

A

Regular: 300/squares between R-R

Irregular: how many QRS complexes in 30 squares x 10

21
Q

Long term Pharmacological treatment of permanent AF

A
  1. DOAC - apixaban
  2. Rate control - beta blocker
  3. Rhythm control

If failed - ablation

22
Q

Respiratory causes of AF

A

Chest infection

Lung cancer

23
Q

Systemic causes of AF

A

Excessive alcohol
Hyperthyroidism
DM

24
Q

Management of paroxysmal AF

A

Self limiting
Pill in pocket - sotalol or flecainide
Anticoag - CHADVASC

25
Q

Type of AF

A

Paroxysmal - terminates spontaneously within 7 days
Persistent AF - lasts more than 7 days but terminates
Permanent - long term continuous AF, sinus rhythms not achievable

26
Q

Why is anticoagulant given for 3 weeks before rythmn control drugs

A

Rhythms control drugs may mask clots

27
Q

When to give rhythm control first line in Persistent AF management

A

young < 65 yo
Symptomatic
Presenting first time
Secondary to already treated precipitant

28
Q

Atrial flutter mx

A

Manage as for AF
• Amiodarone to restore sinus
• Amiodarone or sotalol to maintain it

29
Q

Contraindications for beta blockers

A

Asthma

29
Q

Catheter ablation

A
  1. Anticoagulate 4 weeks before procedure
  2. Percutaneous procedure via groin
  3. Still require anti coagulation lifelong after
30
Q

Complications of catheter ablation

A

Cardiac tamponade
Stroke
Pulmonary valve stenosis

31
Q

If CHADVAS = 0 - 1

A

Ensure a transthoracic echocardiogram has been done to exclude valvular heart disease

32
Q

SVT management

A
  1. Vagal manoeuvre- vasalva or carotid sinus massage
  2. IV adenosine
    - if asthmatic give verapamil
  3. Electric cardio version
33
Q

Broad complex tachycardia

A

Regular - amiodarone

Irregular - refer to cardiologist

Year 3 Cardiology (11 decks)

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