CCC - AF Flashcards
How common is AF?
10% people over 65yrs
What is paroxysmal AF?
Occurs sometimes, stops by itself
Can last seconds - days
What is persistent AF?
AF that does not stop by itself
Requires medications or cardioversion
What is permanent AF?
AF that cannot be corrected
What is the pathophysiology of AF?
Irregular atrial rhythm causes by rapidly firing cells at the junction of the pulmonary vein in the LA
How does AF cause irregular ventricular rhythm?
AV node receives more impulses than it can conduct -> irregular rhythm
Untreated rhythm often 160-180bpm
What are common causes of AF? (4)
IHD
HTN
Valvular disease
Hyperthyroidism
What are some less common causes of AF?
PE Caffeine Post-operation Low K+ or Mg2+ Lung cancer Atrial myxoma Endocarditis
What are some features of AF?
Breathless
Palpitations
Syncope
Fatigue
What are some signs of AF?
Irregularly irregular pulse
Apical pulse is greater than radial pulse
What are some complications of AF?
Stroke
Heart failure
Cardiomyopathy
Reduced QoL
What will an ECG show in AF?
Absent P-waves
Irregular QRS and PR intervals
Choatic baseline
Tachycardia
What blood tests should you perform in AF? (7)
U+E TFT Cardiac enzymes BNP Calcium Magnesium Glucose
What might an echo show win AF?
Enlarged LA
Mitral valve disease
What tests do you need in paroxysmal AF?
24hr ambulatory ECG
Event recorder if episodes >24hrs apart
When do you need an echo in AF?
If considering cardioversion
If there is a high risk of stuctural/functional heart disease
What is in CHA2DS2-VASc score?
CHF HTN Age >75yrs (2) DM Stroke/TIA (2) Valvular disease Age 65-74yrs Female
What does the CHA2D2-VASc score mean?
0-2 = Aspirin
>1 in men or >2 in women = Warfarin
What is in HAS-BLED?
HTN Abnormal Liver or Renal function Stroke Bleeding disorder Labile INR Elderly >65yrs Drugs (eg. NSAIDs) or Alcohol use
What are the options for anticoagulation in AF?
Warfarin Apixaban Rivaroxaban Dabigatran Etexilate
When to offer anticoagulation in AF?
CHADS-VASc
>1 in men
>2 in women
What is the first line treatment of AF?
Rate control
What medications are used for rate control in AF?
Beta-blocker eg. bisoprolol
Diltiazem
Who would you not consider rate control in immediately for AF? (3)
AF with reversible cause (eg. hyperthyroidism)
Heart failure secondary to AF
New-onset AF
