[Cardio] Atrial Fibrillation Flashcards
what are the causes of AF?
"Mrs SMITH has AF" Sepsis Mitral valve stenosis Ischaemic heart disease Thyrotoxicosis Hypertension
how is a dx of AF made?
clinical examination (irregular pulse) + ECG (irregularly irregular, narrow complex tachycardia, absent P waves)
may need Holter monitor to dx paroxysmal AF
+ ECHO to assess for heart failure and structural heart disease in guiding long-term mx
what is paroxysmal AF?
AF that terminates <7 days of onset
what is persistent AF?
AF that fails to terminate in <7 days, episodes often require cardioversion to restore sinus rhythm
what is permanent AF?
AF that lasts >12 months and no longer pursuing rhythm control options
how do you manage AF?
depends if stable or unstable
how do you manage stable AF?
rate vs rhythm control
when do you use rate control in stable AF?
if onset >48 hours or uncertain
what is 1st line for rate control in stable AF?
beta-blockers
what other drugs could be used for rate control in stable AF?
CCBs, digoxin
when do you use rhythm control in stable AF?
- acute onset AF <48 hours
- heart failure caused by AF
- pts who remain symptomatic despite rate control
what can be used for rhythm control in stable AF?
- flecainide
- sotalol
- amiodarone
- AF ablation
what can be considered for resistant, symptomatic AF?
ablation
unstable AF is an emergency as it causes a life-threatening haemodynamic unstability. what are the features of unstable AF?
- hypotensive
- chest pain
- acute heart failure
how is unstable AF managed?
urgent DC cardioversion
all pts with AF need to be assessed for the need of long-term anticoagulation. what scoring systems are used?
CHADs-VASC and HASBLED
what is CCB and Flecainide contra-indicated in?
structural heart disease
what is the MOA of warfarin?
vit K antagonist
what is the dosing for warfarin?
INR-adjusted
what is the reversal agent for warfarin?
vit K PO / IV
what is the MOA of apixaban and rivaroxaban?
direct FXa inhibitor
what is the MOA of dabigatran?
direct thrombin inhibitor
dabigatran is the only DOAC with a reversal agent. what is it?
idarucizumab
what is the only anti-coagulant licensed for metallic valve replacement?
warfarin
INR 3-4
