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Cardiology > Atrial fibrillation/arrythmia > Flashcards

Atrial fibrillation/arrythmia Flashcards

1
Q

Paroxysmal AF

A

Terminates spontaneously/with treatment within 7 days of onset

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2
Q

Persistent AF

A

Continuous and sustained for more than 7 days

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3
Q

Long-standing persistent AF

A

Continuous and sustained for more than 12 months

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4
Q

Permanent AF

A

Joint decision by patient and clinician to cease attempts to restore sinus rhythm

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5
Q

Lone AF

A

AF with no identifiable cause (around 10% patients)

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6
Q

Commonest causes of AF (4)

A

Coronary heart disease
Hypertension
Valvular heart disease
Hyperthyroidism

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7
Q

Rate control is first-line except: (4)

A

Reversible cause
Heart failure
New onset AF
For whom rhythm control is judged more suitable

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8
Q

First-line treatment options for rate control in AF (3)

A

Beta-blocker
Rate-limiting calcium channel blocker
Digoxin

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9
Q

When would digoxin be indicated for rate control?

A

Sedentary patients where other drug options are ruled out due to co-morbidity or patient preferences

Where co-exists with heart failure

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10
Q

If monotherapy does not control symptoms, what is second-line?

A

Combination of two of beta-blocker, diltiazem, digoxin

seek specialist advice prior to co-prescription of diltiazem + beta blocker

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11
Q

Drug methods of rhythm control? (3)

A

Amiodarone
Flecainide
“Pill in the pocket” for pAF

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12
Q

Investigation prior to commencing flecainide or dronedarone?

A

Echo- these drugs contraindicated in structural cardiac disease

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13
Q

Amiodarone toxicity? (4)

A

Pulmonary toxicity
Hypothyroidism
Hepatotoxicity
Corneal deposits

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14
Q

CHA2DS2VaSc criteria?

A 
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)
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15
Q

When should anticoagulation be considered?

A

All with CHADSVASC = 2 and men with CHADSVASC = 1

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16
Q

HASBLED criteria?

A

(uncontrolled) Hypertension
(haemorrhagic) Stroke
Bleeding tendency
Labile INR
Elderly >65
Drugs e.g. aspirin, ibuprofen

17
Q

First-line anticoagulants in AF

A

NOAC e.g. apixaban, rivaroxaban

18
Q

eGFR limit for apixaban/rivaroxaban?

A

> 30

19
Q

Time in therapeutic range (TTR) aim for warfarin?

A

> 65%

20
Q

Non-drug means of rhythm control? (2)

A 
DC cardioversion (acute if unstable or planned)
Left atrial catheter ablation
21
Q

When is pharmacological cardioversion preferred to electrical?

A

In the acute phase <48 hours, DC preferred if prolonged AF

22
Q

How long should a patient be anticoagulated for prior to DC cardioversion?

A

3 weeks

23
Q

Options for rhythm control in atrial flutter? (3)

A

Radiofrequency catheter ablation (preferred)
Pacing
Pharmacological cardioversion

24
Q

Management of recurrent episodes of SVT? (3)

A

Catheter ablation
Rate-limiting Ca blockers
Beta blockers

25
Q

Role of rate control in atrial flutter?

A

Control of rate pending eventual rhythm control strategy

26
Q

Pathological causes of bradycardia

A

Inferior MI
Sick sinus syndrome
Hypothyroidism
Raised ICP

27
Q

1st degree heart block

A

PR > 200 msecs

28
Q

2nd degree block Mobitz I

A

progressive lengthening of PR interval with eventual dropped beat

29
Q

2nd degree block Mobitz II

A

constant prolonged PR interval with regular dropped beats (e.g. 2:1 pattern)

30
Q

3rd degree block

A

constant P-P intervals and R-R intervals but no relationship between P waves and QRS complexesd

31
Q

Management of heart block?

A

1st degree- monitor

2nd/3rd degree- refer to cardiology, urgent emergency admission if symptomatic bradycardia

32
Q

Condition causing ventricular arrythmias +/- syncope/sudden death, often occuring at night, particularly affecting SE Asian populations

A

Brugada syndrome

33
Q

Inheritance of Brugada syndrome

A

Autosomal dominant, only 50% patients have a family history

34
Q

Congential accessory conduction pathway, ECG demonstrates delta wave

A

Wolff-Parkinson-White syndrome

35
Q

Change from lying - standing causing exaggerated orthostatic response in pulse > 30bpm

A

Postural tachycardia syndrome

36
Q

Diagnostic test for POTS?

A

Tilt-table testing

Cardiology (13 decks)

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