Cardiovascular: Atrial Fibrillation

Question 1

what is atrial fibrillation?

Answer 1

an arrhythmia resulting from irregular electrical activity in the atria, leading to an irregular ventricular rhythm.

Question 2

what is paroxysmal AF?

Answer 2

episodes lasting longer than 30seconds but less than 7days (often less than 48hours) that are self-terminating and recurrent.

Question 3

what is persistent AF?

Answer 3

episodes lasting longer than 7days (spontaneous termination of the arrhythmia is unlikely to occur after this time) or less than seven days but requiring pharmacological or electrical cardioversion.

Question 4

what is permanent AF?

Answer 4

AF that fails to terminate using cardioversion, AF that is terminated but relapses within 24hours, or longstanding AF (usually longer than 1year) in which cardioversion has not been indicated or attempted (sometimes called accepted permanent AF).

Question 5

what signs on examination would show with a patient who has AF?

Answer 5

Irregularly irregular pulse / fast heart rate (often 140-180bpm).

Question 6

what are some cardiac risk factors for AF?

Answer 6

Congestive heart failure.
Rheumatic valvular disease.
Atrial or ventricular dilation or hypertrophy.
Pre-excitation syndromes (such as Wolff–Parkinson–White syndrome).
Sick sinus syndrome.
Congenital heart disease.
Inflammatory or infiltrative disease (such as pericarditis, amyloidosis, or myocarditis).

Question 7

what are some dietary and lifestyle risk factors for AF?

Answer 7

Excessive caffeine intake.
Alcohol abuse.
Obesity.
Smoking.
Medication exposure (such as thyroxine or bronchodilators).

Question 8

What are some clinical features of AF?

Answer 8

Breathlessness. 
Palpitations. 
Chest discomfort. 
Syncope or dizziness. 
Reduced exercise tolerance, malaise/listlessness, decrease in mentation, or polyuria.
Irregular pulse. 

NB: many people are asymptomatic

Question 9

what investigations would you do to confirm a diagnosis of AF?

Answer 9

ECG (will haveno P-waves, a chaotic baseline, narrow QRS complex tachycardia, and an irregular ventricular rate)

Question 10

What will an ECG look like for a patient with AF?

Answer 10

• no P-waves
• chaotic baseline,
• narrow QRS complex
• tachycardia

Question 11

If paroxysmal AF issuspectedand AF is not detected on standard ECG, what investigation should you conduct?

Answer 11

arrangea 24-hour ambulatory ECG monitor

Question 12

what is the treatment for reversible AF?

Answer 12

cardio version:

1. Pharmacological – First line is Flecanide or Amiodarone (drug of choice in people with structural heart disease).
2. Electrical – Cardiac defibrillator.

Question 13

what is the treatment for irreversible AF?

Answer 13

Rate control is the first-line treatment:

Beta blocker and/or Calcium channel blocker