FN: Atrial Fibrillation

Question 1

Pathology

Answer 1

LA lose refractories before the end of atrial systole–> recurrent uncoordinated contraction
Atrial contraction responsible for 25% of CO therefore often triggers heart failure

Question 2

Causes common

Answer 2

IHD
Rheumatic heart disease
Thyrotoxicosis
Hypertension

Question 3

Other causes

Answer 3

Alcohol
Pneumonia
Pe
Post-op
Hypokalaemia
RA

Question 4

Symptoms

Answer 4

asymptomatic
Chest pain
Palpitations
Dyspnoea
Faintness

Question 5

Signs

Answer 5

Irregularly irregular pulse
Pulse deficit: difference between pulse and HS
–> Fast AF - loss of diastolic filling - no palpable pulse

Signs of LVF

Question 6

Investigation

Answer 6

ECG
FBC, U+E, TFTs, Troponing
Consider TTE: structural abnormalities

Question 7

Acute AF (

Answer 7

Haemodynamically unstable - emergency cardioversion (IV amiodarone 2nd line)

Question 8

Acute AF Control ventricular rate

Answer 8

1st line: diltiazem or verapmil or metoprolol

2nd line: digoxin or amiodarone

Question 9

Acute AF start

Answer 9

LMWH

Question 10

Cardioversion use when

Answer 10

acute AF

Question 11

Pharmacological cardioversion

Answer 11

1st: flecainide, propafenone
2nd: Amiodarone

Question 12

Paroxysmal AF

Answer 12

1. Self-limiting

Question 13

Persistent AF

Answer 13

> 7d may recur even after carioversion

Question 14

Attempt rhythm control as first-line in persistent AF if

Answer 14

1. Symptomatic or CCF

2. Younger (

Question 15

Rhythm Control

Answer 15

1. TTE first: structural abnormalities
2. Anticoagulate with warfarin for >3wks
3. Pre-Rx >4 wks wth sotalol or amiodarone if increased risk of failure
4. Electrical or pharmacologcal cardioversion
5. > 4 wks anticoagulation afterwards (target INR 2.5)

Question 16

Maintenance antiarrhythmic

Answer 16

Not needed if sucessfully treated precipitant

1st: Beta-blovker (e.g. bisoprolol, metoprolol)
2nd: amiodarone

Question 17

Other options

Answer 17

Radiofreqeuncy ablation of AV node
Maze procedure
Pacing

Question 18

Rate control (target

Answer 18

1st line: beta-blocker or rate-limiting CCB (not both)
2nd line: add digoxin (dont use as monotherapy)
3rd line: consider amiodarone

Question 19

Management of permanent AF

Answer 19

1. Failed cardioversion/unlikely to suceed –> AF >1yr, valve disease, poor LV function
2. Pt. doesnt want cardioversion
3. Rate control

Question 20

Management of Atrial flutter

Answer 20

Manage as for AF
Anti-AF drug may not work but try:
1. amiodarone to restore sinus
Amiodarone or sotalol to maintain it

2. Cavotricuspid isthmus ablation (RA) is Rx of choice

Question 21

CHADSVas score

Answer 21

Determines necessity of anticoagulation in AF

Question 22

Warfarin contraindications

Answer 22

Bleeding diatheis
reduced platelets
BP >160/90
Poor compliance

Question 23

CHADS VAS stands for

Answer 23

CCF
HTN
Age >75 (2 points)
DM
Stroke or TIA(2 points)
Vascular disease
Age: 65-75yrs
Sex: female

Question 24

CHADSVAS score of 0

Answer 24

aspirin 300mg

Question 25

CHADSVAS of >1

Answer 25

Warfarin