atrial fibrillation- passmedicine

Question 1

rate vs rhythm control

Answer 1

rate control: accept that the pulse will be irregular, slow the rate to avoid negative affects
rhythm control: try to get the patient back into normal sinus= cardioversion, can be drugs or synchronised DC shocks

Question 2

when would you not use the rate control strategy for AF

Answer 2

coexistent heart failure
first onset AF
obvious reversible cause
new onset < 48 hours

Question 3

rate control for AF

Answer 3

beta blocker
rate-limiting calcium channel blocker (diltiazem)
if one drug not enough then use any two of these:
- beta blocker
- diltiazem
- digoxin

Question 4

what to consider before changing to rhythm control management of AF

Answer 4

patients need to have had short duration of symptoms < 48 hours or
be anticoagulated for period of time before cardioversion
prevent embolism

Question 5

atrial fibrillation management post TIA/stroke

Answer 5

exclude haemorrhage first
warfarin, direct thrombin or factor Xa inhibitor

TIA: anticoag immediately
acute stroke: anticoag after 2 weeks, antiplatelet given in meantime

Question 6

drugs used for pharmacological cardioversion of AF

Answer 6

amiodarone
flecainide (if no structural heart disease)

Question 7

management of patients presenting acutely with AF that are haemodynamically unstable

Answer 7

electrically cardioverted

Question 8

management if AF < 48 hours

Answer 8

heparinised
lifelong oral anticoag if risk of stroke
cardioverted: electrical or pharmacological

Question 9

management of patients following electrical cardioversion

Answer 9

anticoagulated for at least 4 weeks