GP teaching

Question 1

Heart flutter differentials

Answer 1

Cardiac - HTN, IHD, CCF, AF, Valve pathologies
Systemic - endocrine hyperthyroidism, metabolic, infective, haematological (anaemia)
Psych - anxiety/stress
Iatrogenic - caffeine, drugs, alcohol

Question 2

Investigations

Answer 2

Urgent ECG
24 hour ECG if intermittenet
Bloods
Echo
CXR in case cancer
MSU

Question 3

AF management

Answer 3

Rate control
Rhythm control

Question 4

Q risk score

Answer 4

Risk of someone getting a heart attack or stroke

Question 5

What is the CHADVASC score

Answer 5

AF -

Question 6

Rate control

Answer 7

Less than 48 hours ago - start with rhythm control, cardioversion in hospital

Question 8

What if someone has had AF for more than 48 hours

Answer 8

Anti coag for 3 weeks so that you

Question 9

if worsening HF from AF - mx

Answer 9

Rhythm control

Question 10

When do you do rhythm control

Answer 10

new onset AF within 48 hours
Reversible cause
has it precipated HF and their HF is worsening/getting really bad

Question 11

Drugs for rate control

Answer 11

Beta blockers - bisoprolol
Diltiazem - ccb which are rate limiting

Question 12

Which ccb is non rate limiting which we do not use here

Answer 12

amlodipine - non rate limiting

Question 13

rhythm control

Answer 13

cardioversion

Question 14

How do you assess stroke risk

Answer 14

CHADVACS - risk of stroke
ORBIT - risk of bleed

You have to compare

Valvular/non-valvular
DOAC vs warfarin

Question 15

Valvular heart disease - what medication

Answer 15

warfarin

Question 16

AF MANAGEMENT - FINAL

Answer 16

AF management requires both rate/rhythm control AND anticoagulation

Determining whether someone needs rate control or rhythm control

Ask:
Do they meet the criteria for rhythm control?
Was it in last 48 hours? - Rhythm control
Does this pt have a reversible cause of AF? e.g. sepsis - if so, rhtyhm control
Have they suddenly got into HF or worsened HF, then go for rhythm control

Electrical and pharmacological cardioversion
If structural heart disease, you can’t give sotolol or flecanide

If not, go for rate control - beta blockers and rate limiting CCB

Anticoagulation

CHADSVASC vs ORBIT score comparison
Use DOAC on everyone unless they hvae severe renal failure, valvular heart problems or antiphospholipid sydnrome - use warfarin

Question 17

When would you give warfarin over DOACs

Answer 17

Valvular heart disease
Severe renal failure
Antiphospholipid syndrome

Question 18

ORBIT replaced which scoring system

Answer 18

HASBLED