Cardio AF Flashcards
what type of arrhythmia is AF
supraventricular
what is the typical ventricular rate of AF
180
what are the three types of af
paroxysmal
persistent
permanent
what is paroxysmal af
episodes lasting longer than 30 seconds but less than 7 days (often less than 48 hours) that are self-terminating and recurrent
what is persistent af
episodes lasting longer than 7 days (spontaneous termination of the arrhythmia is unlikely to occur after this time) or less than seven days but requiring pharmacological or electrical cardioversion
what is permanent AF
AF that fails to terminate using cardioversion, AF that is terminated but relapses within 24 hours, or longstanding AF (usually longer than 1 year) in which cardioversion has not been indicated or attempted (sometimes called accepted permanent AF)`
what are the three most common associations with AF
hypertension
coronary artery disase
MI
what are the main complications of AF
stroke
thromboembolism
heart failure due to ineffective ventricular filling
what reduces the risk of stroke in af by 2/3rds
anticoagulation
what non cardiac conditions raise suspicion of AF
diabetes
thyroid disease
cancer
alcohol misuse
if someone has palpitations chest discomfort and breathlessness which are episodic and last less than 48 hours what should you suspect
paroxysmal af
how do you diagnose AF
ECG
what is seen on an ecg of af
no p wave s
irregular
ventricular rate of 180
what do you do if paroxysmal AF is suspected and AF is not detected on ECG
24 hour ECG monitor if less than 24 hrs between symptoms
If more than 24 hours between symptoms use either an event recorder or a 7 day holter monitor
what is the differential diagnosis of an irregular pulse
af atrial flutter atrial extrasystole ventricular ectopics sinus tachy svt
what are the main reported symtpoms of AF
breathlessness s
chest discomfort
palpitations
irregular heart beat
If the onset of atrial fibrillation (AF) was within the last 48 hours and is showing signs of haemodynamic instability: how do you manage them?
urgent admission for cardioversion
what is classed as haemodynamic instability
rapid pulse (greater than 150 beats per minute) and/or low blood pressure (systolic blood pressure less than 90 mmHg), loss of consciousness, severe dizziness or syncope, ongoing chest pain, or increasing breathlessness
If the onset of atrial fibrillation (AF) was within the last 48 hours and is NOT showing signs of haemodynamic instability: how do you manage them?
either cardioversion or management in primary care dependent on clinical judgment and patient preference
for all people with diagnosed AF what should you do
rule out cardiac and non cardiac underlying causes so arrange echo
AF with lung cause suspected arrange
CXR
if systemic cause suspected arrange
FBC TFTS UE electrolyte calcium magnesium and glucose measurements
what to do to reduce AF episodes
weight loss treat underlying cause such as diabetes hypertension and sleep apnoea
when to refer to a cardiologist
WPW valvular disease suspected HF
what do you do if af with thyroid disease suspected
refer to endocrine
how do you assess a persons stroke risk
chad2vas score
when is anticoagulation indicated
chad2vas score of 2 in females and 1 or more in males
what is important to remember when prescring anticoagulation
has bled assessment score
what are the modifiable risk factors for bleeding for a person needing anticoagulation
uncontrolled hypertension, harmful alcohol consumption, and concurrent use of aspirin or a nonsteroidal anti-inflammatory drug
what is most commonly used anticoag in af
apixaban, dabigatran etexilate, rivaroxaban, or a vitamin K antagonist
what is first line treatment for most people with AF
beta blocker or rate limiting ccb
which beta blocker should NOT be used in af
sotalol
what should you do after starting therapy
arrange follow up in 1 week
people whose symptoms continue after heart rate has been controlled or for whom a rate‑control strategy has not been successful should be
referred for cardioversion
describe the cha2ds2vasc score?
congestive heart failure/ left ventricular dysfunction hypertension age >75 = 2 diabetes mellitus stroke/ tia = 2 vascular disease sge 65-74 female
describe the haasbled score
hypertension abnormal liver / renal function stroke bleeding labile INR >65yo drugs (antiplatelets/ nsaids) harmful alcohol consumption
For people taking a rate-control treatment who have persistent symptoms of AF or a fast heart rate, consider one of the following options
give maximum rate control drugs
consider combination of beta blocker digoxin and diltiazem
refer to a cardiologist for rhythm control if
af of reversible cause
heart failure caused or worsened by the af
what are the main rhythm control drugs
amiodarone
sotolol
Seek specialist advice before prescribing diltiazem with a ……….. because
beta-blocker because bradycardia, atrioventricular block, asystole, or sudden death can occur with concurrent use
what is ecg like for atrial flutter
sawtooth appearance
rate of 300bpm
how do you treat atrial flutter
same as af
what is the aim of rate control
normalise the ventricular rate
what is the aim of rhythm control
Terminating atrial fibrillation and restoring it to sinus rhythm in order to prevent atrial remodeling
what is first second and third line rate cnrtol
1 - beta blockers or diltiazem/ verapamil
2 - digoxin
3 - amiodarone
what is first and second line rhythm cnrtol
1 - cardioversion
2 - flecainide
