Clinical Management of Atrial Fibrillation Flashcards
1
Q
Arrhythmia
A
- Abnormal rate or rhythm of heat rate
- Patient >65 or those with hypertension risk
2
Q
Measure pulse
A
- Measure 30s of heart rate by radial pulse multiply by 2
- Check regularity
3
Q
ECG
A
- Standard electrogram
- P wave shows that AV node is working properly
- QRS complex which is the depolarization
- T wave shows repolarization
4
Q
What happens happens to ECG at AF
A
- SA node fire multiple times
- May start in the atrium or anywhere else
- AV node ignore and regulate
- P wave disappear
5
Q
Ectopic beats
A
- Common and harmless
6
Q
Arterial fibrillation
A
- Common to sustain normal heart rate and rhythm
- Irregular complex of beats no P wave
7
Q
Ventricular tachycardia
A
- Regular but fast heart rate
8
Q
Ventricular fibrillation
A
- Most common life threatening arrhythmias
9
Q
Paroxysmal AF
A
- Episodes come and go stop within 48hrs of any treatment
10
Q
Persistent AF
A
- Each episode longer than seven days
11
Q
Long standing persistent AF
A
- Consistent AF for a yr or longer
12
Q
Permeant AF
A
- Present for a long time
13
Q
Symptoms of AF
A
- Asymptomatic in older people
- Palpitations
- Tiredness
- Dizziness
- Chest pains
14
Q
AF prognosis
A
- Common in older people >65 women
- Most like with people that have hypertension or atherosclerosis
- Good with treatment not life threatening
- Heart failure ventricles work too hard possible stroke
15
Q
Goals of management
A
- Establish diagnosis
- Control and prevent symptoms so stroke can be prevented
16
Q
Ambulatory ECG
A
- Paroxysmal AF portable therefore can detect the arrythmias worn for a week
17
Q
Treatment
A
- Admit if necessary and manage underlying causes and triggers
- Rate control and rhythm control to prevent stroke
- Do thyroid test and undiagnosed hypertension
18
Q
Rate control via beta blockers
A
Atenolol, metoprolol and bisoprolol
19
Q
Adverse effects of beta blockers
A
- Bronchospasm and cold extremities
- Sleep disturbances
20
Q
Rate control by rate limiting calcium blockers
A
- Verapamil and diltiazem
21
Q
Adverse effects of rate limiting calcium channel blockers
A
- Dizziness palpitations
- GI disturbances
- Bradycardia
- Drug interactions
22
Q
Digoxin monotherapy as rate control
A
- In people with non paroxysmal AF who are sedentary
23
Q
Adverse effects of digoxin
A
- Arrythmias, blurred vision
- diarrhea and dizziness
24
Q
Rhythm control
A
- For people with onset AF with reversible causes
- Can be done within 48hrs
25
Q
Flecainide
A
- IV loaded then oral dosing
- Adverse effects dizziness fatigue fever
- Class Ic antiarrhythmic
26
Q
Amiodarone
A
- Class III antiarrhythmic
- Bradycardia
- hyperthyroidism
- Jaundice
27
Q
Electrical cardioversion
A
- Patient sedated for short time
28
Q
Catheter ablation
A
- Carried out in vein of groin
- Area of heart causing abnormal electrical discharge destroys radio frequency
- AV node pacemaker returns to normal sinus rhythm
29
Q
Stroke prevention
A
- Thrombosis stagnation of blood in atria and incomplete blood emptying cause embolism in brain
- Changes in the vessel wall
- Changes in the constituents of the blood
- Changes in the blood flow
30
Q
Stroke prevention
A
- CHA2-DS2-VASc stratification of stoke
- Diabetes, heart failure, hypertension and age
31
Q
Score and risk
A
- > 2 then use anticoagulation
- 1 and male consider anticoagulation
- 0/1 and female then anticoagulation not recommend
32
Q
What do you not offer for someone that has stroke prevention in AF
A
- No antiplatelet drugs as it is not as effective compared to anticoagulation
33
Q
Bleeding risk
A
- Risk score calc by abnormal liver function and hypertention
- HAS-BLED
34
Q
ORBIT risk score
A
- less modifiable risks so tend to use HAS-BLED
35
Q
Direct acting anticoagulant
A
- Dabigatran - direct thrombin inhibitor
- Apixaban and Rivaroxaban direct Xa inhibitor
36
Q
Vitamin k antagonist
A
- Warfarin
- Acenocoumarol
37
Q
DOACs vs warfarin
A
- More common compared to Warfarin - metal heart valve renal impairment put warfarin
- Standard dosing and no monitoring INR needed
- Large number of interactions
- most common adverse effects bleeding
- Difficult to reverse the effects
38
Q
DOACs dosing
A
- Based on renal function and weigh and ensure blood pressure is correct
39
Q
Monitoring
A
- Annual blood test
- > 75 yrs need to be monitored 6 months
- Monitor creatinine clearance
40
Q
Annual review
A
- Check adherence
- Specific dosing advice dabigatran keep in packet and rivaroxaban take with food
- Missed dose monitoring
- Alcohol intake and bleeding
41
Q
INR and risk of VTE
A
- Normal is 1 and AF reading is 2.5-3
