Atrial fibrillation/flutter

Question 1

Define atrial fibrillation:

Answer 1

Rapid chaotic + ineffective atrial conduction @ 300-600 bpm

Question 2

Define atrial flutter:

Answer 2

SVY caused by re-entry circuit which causes constant atrial depolarisation @ a rate of 200-400 bpm

Question 3

Aetiology:

Answer 3

Atrial flutter is usually caused by an underlying heart disease which means that heart cells become irritable –> more likely to allow a re-entrant circuit

Atrial fibrillation is due to increased stress on the atrium leading to tissue heterogeneity.

Question 4

Risk factors:

Answer 4

Pneumonia

COPD and asthma (atrial flutter)

Valvular disease (mainly mitral stenosis in atrial fibrillation)

Hypertension

Diabetes mellitus

Hyperthyroidism

post surgical

alcohol

IHD or MI

Question 5

Epidemiology of atrial fibrillation:

Answer 5

very common in the elderly

> 5% of those over 65

May be paroxysmal

more common in women

Question 6

epidemiology of atrial flutter:

Answer 6

common in the elderly - older you are the greater the risk

more common in men

25-35% have atrial fibrillation

mostly have a co-morbidity

Question 7

Symptoms:

Answer 7

syncope

dizziness and faints

SOB

chest pain

fatigue

nausea

Question 8

Signs of atrial flutter:

Answer 8

raised pulsatile JVP

hypotension

signs of thyroid or valvular disease

worsening symptoms of HF or pulmonary symptoms

Question 9

Investigations:

Answer 9

ECG - A. Fib + irregularly irregular with absent P wave. A. flutter = saw tooth pattern

Bloods - Cardiac enzymes, TFT, U+Es, lipids

Echo

CXR - cardiomegaly/pneumonia

Question 10

Management:

Answer 10

Rate control:
> Verapamil or bisoprolol
>Digoxin or amiodrone (2nd line)

Anticoagulant:
> If less than 48 hours then cardioversion
> Warfarin or DOACs

Question 11

Complications:

Answer 11

Thromboembolsim

BIGGEST RISK IS EMBOLIC STROKE

worsening HF

MI

Question 12

Prognosis:

Answer 12

Chronic A.fib will not return to sinus rhythm