Cardiology

Question 1

What is paroxysmal AF?

Answer 1

Episodes stop within 48 hours without treatment

Question 2

What is persistent AF?

Answer 2

Episodes last > 7 days

Question 2

What are the two aims of treatment for arrythmias?

Answer 2

Rate control: controls ventricular rate
Rhythmn control: Restores and maintains sinus rhythmn

Question 3

What is permanent AF?

Answer 3

AF is present all the time

Question 4

What are the symptoms of AF?

Answer 4

Heart palpitations
Dizziness
SOB
Tiredness

Question 5

What are the complications of AF?

Answer 5

Stroke and heart failure

Question 6

How should patients who present with acute new-onset AF with life-threatening haemodynamic instability be treated?

Answer 6

Electrical cardioversion
- Give parenteral anticoagulant and rule out atrial thrombus immediately before procedure

Question 7

How should patients who present with acute new-onset AF without life-threatening haemodynamic instability be treated?

Answer 7

<48 hours = rate or rhythm control (electrical or amiodarone/flecanide)
>48 hours = rate control (verapamil, beta blocker)

Question 8

What can be given if urgent rate control is required?

Answer 8

IV beta blocker
Verapamil (if LVEF >40%)

Question 9

When should calcium channel blockers be avoided in AF?

Answer 9

In patients with suspected concomitant acute decompensated HF

Question 10

What can be given for pharmacological cardioversion?

Answer 10

Flecainide (if no structural or IHD)
Amiodarone

Question 11

Why is cardioversion not recommended if symptoms are present >48 hours?

Answer 11

Increased risk of stroke
(Clots can pool in atria which can be released when shocked and go to the brain)

Question 12

How long does a patient need to be anticoagulated for before cardioversion?

Answer 12

Fully anticoagulated for 3 weeks before and continue for 4 weeks after

Question 13

What is the first line treatment strategy for maintenance of AF?

Answer 13

Rate control
Beta blockers - (not sotalol), rate limiting CCB, digoxin

Question 14

When is rate control not the preferred first line treatment strategy for AF?

Answer 14

In patients with new onset AF
With atrial flutter suitable for ablation
AF with a reversible cause
Heart failure primarily caused by AF

Question 15

When should digoxin monotherapy only be considered for initial rate control?

Answer 15

Those with non-paroxysmal AF who are predominantly sedentary
Those where other rate limiting drugs are unsuitable

Question 16

What should be considered if monotherapy fails to adequately control ventricular rate?

Answer 16

Dual therapy: BB (not sotalol), rate-limiting CCB, digoxin
If this fails - rhythm control should be considered (beta blockers or oral anti-arrhytmic drugs)

Question 17

If LVEF <40% what combination of drugs should be used to control ventricular rate?

Answer 17

Beta blocker
Digoxin

Question 18

What drugs should be given if rhythm control is still required post cardioversion?

Answer 18

First line: Beta blockers (not sotalol)
Second line: Oral anti-arrhythmic drugs
e.g. sotalol, amiodarone, flecainide, propafenone, dronedarone

Question 19

What does ‘Pill in Pocket’ mean?

Answer 19

For patients with paroxysmal/symptomatic AF
Infrequent episodes - able to self treat with flecainide or propafenone

Question 20

What anti-arrhythmic drugs are contra-indicated in asthma / severe COPD?

Answer 20

Flecainide
Propafenone

Question 21

What anti-arrhythmic drugs are contra-indicated in structural / IHD?

Answer 21

Flecainide
Propafenone

Question 22

What is the treatment for atrial flutter?

Answer 22

Similar treatment as Afib but catheter ablation more suitable

Question 23

What is included n the CHADSVASc tool?

Answer 23

C = chronic HF or LVD
H = HTN
A = 75+
D = T2DM
S = Stroke/TIA/VTE history
V= Vascular disease
A= 65-74 years
S= Sex category