Atrial fibrillation/flutter Flashcards
Atrial fibrillation?
Characterised by rapid, chaotic and ineffective atrial electrical conduction. Often subdivided into permanent, persistent, paroxysmal. secondary causes lead to an abnormal atrial electrical pathway that results in AF.
Atrial fibrillation Systemic causes (4)?
thyrotoxicosis, hypertension, pneumonia, alcohol.
Atrial fibrillation heart causes (6)?
mitrial valve disease, ischaemic heart disease, rheumatic heart disease, cardiomyopathy, pericarditis, sick sinus symdrome, atrial myxoma
Atrial fibrillation lung causes (2)?
bronchial carcinoma, PE.
Atrial fibrillation epidemiology?
common in elderly, 5% of >65, may be paroxysmal.
Atrial fibrillation Symptoms?
often asymptomatic, syncope (if low output) symptoms of cause.
Atrial fibrillation signs?
irregularly irregular pulse, difference in apical beat and radial pulse, check for signs of thyroid disease and valvular disease.
Atrial fibrillation Investigations ECG?
uneven baseline with absent p waves, irregular intervals between QRS complexes, atrial flutter=saw-tooth
Atrial fibrillation Investigations bloods?
cardiac enzymes, TFT, lipid profile.
Atrial fibrillation Investigations echo-cardiogram?
may show mitral valve disease, left atrial dilation, left ventricular dysfunction, structural abnormalities
Atrial fibrillation management?
treat any reversible causes (thyrotoxicosis, chest infection) then rate + rhythm control.
Atrial fibrillation management rhythm control?
if >48hrs since onset; anticoagulate for 3-4 weeks before cardioversion.
If <48 hours since onset; DC cardioversion + chemical cardioversion (flecainide or amiodarone).
Atrial fibrillation management rate control?
for chronic AF, control ventricular rate with digoxin, verapamil, beta blockers, aim for ventricular rate 90bpm.
If low stroke risk manage with aspirin, if high risk, anticoag with warfarin.
Atrial fibrillation complications?
thromboembolism, embolic stroke risk of 4% per year.
