Atrial fibrillation/arrythmia Flashcards
Paroxysmal AF
Terminates spontaneously/with treatment within 7 days of onset
Persistent AF
Continuous and sustained for more than 7 days
Long-standing persistent AF
Continuous and sustained for more than 12 months
Permanent AF
Joint decision by patient and clinician to cease attempts to restore sinus rhythm
Lone AF
AF with no identifiable cause (around 10% patients)
Commonest causes of AF (4)
Coronary heart disease
Hypertension
Valvular heart disease
Hyperthyroidism
Rate control is first-line except: (4)
Reversible cause
Heart failure
New onset AF
For whom rhythm control is judged more suitable
First-line treatment options for rate control in AF (3)
Beta-blocker
Rate-limiting calcium channel blocker
Digoxin
When would digoxin be indicated for rate control?
Sedentary patients where other drug options are ruled out due to co-morbidity or patient preferences
Where co-exists with heart failure
If monotherapy does not control symptoms, what is second-line?
Combination of two of beta-blocker, diltiazem, digoxin
seek specialist advice prior to co-prescription of diltiazem + beta blocker
Drug methods of rhythm control? (3)
Amiodarone
Flecainide
“Pill in the pocket” for pAF
Investigation prior to commencing flecainide or dronedarone?
Echo- these drugs contraindicated in structural cardiac disease
Amiodarone toxicity? (4)
Pulmonary toxicity
Hypothyroidism
Hepatotoxicity
Corneal deposits
CHA2DS2VaSc criteria?
C- CCF (1)
H- hypertension (1)
A2- age 65-74 (1)
age >74 (2)
D- diabetes (1)
S2- stroke/TIA (2)
Vascular disease history (1)
Sex female (1)When should anticoagulation be considered?
All with CHADSVASC = 2 and men with CHADSVASC = 1
HASBLED criteria?
(uncontrolled) Hypertension
(haemorrhagic) Stroke
Bleeding tendency
Labile INR
Elderly >65
Drugs e.g. aspirin, ibuprofen
First-line anticoagulants in AF
NOAC e.g. apixaban, rivaroxaban
eGFR limit for apixaban/rivaroxaban?
> 30
Time in therapeutic range (TTR) aim for warfarin?
> 65%
Non-drug means of rhythm control? (2)
DC cardioversion (acute if unstable or planned) Left atrial catheter ablation
When is pharmacological cardioversion preferred to electrical?
In the acute phase <48 hours, DC preferred if prolonged AF
How long should a patient be anticoagulated for prior to DC cardioversion?
3 weeks
Options for rhythm control in atrial flutter? (3)
Radiofrequency catheter ablation (preferred)
Pacing
Pharmacological cardioversion
Management of recurrent episodes of SVT? (3)
Catheter ablation
Rate-limiting Ca blockers
Beta blockers
Role of rate control in atrial flutter?
Control of rate pending eventual rhythm control strategy
Pathological causes of bradycardia
Inferior MI
Sick sinus syndrome
Hypothyroidism
Raised ICP
1st degree heart block
PR > 200 msecs
2nd degree block Mobitz I
progressive lengthening of PR interval with eventual dropped beat
2nd degree block Mobitz II
constant prolonged PR interval with regular dropped beats (e.g. 2:1 pattern)
3rd degree block
constant P-P intervals and R-R intervals but no relationship between P waves and QRS complexesd
Management of heart block?
1st degree- monitor
2nd/3rd degree- refer to cardiology, urgent emergency admission if symptomatic bradycardia
Condition causing ventricular arrythmias +/- syncope/sudden death, often occuring at night, particularly affecting SE Asian populations
Brugada syndrome
Inheritance of Brugada syndrome
Autosomal dominant, only 50% patients have a family history
Congential accessory conduction pathway, ECG demonstrates delta wave
Wolff-Parkinson-White syndrome
Change from lying - standing causing exaggerated orthostatic response in pulse > 30bpm
Postural tachycardia syndrome
Diagnostic test for POTS?
Tilt-table testing
