Green Book - AF

Question 1

AF Types:

Answer 1

1. Paroxysmal - Episodes lasting 30 seconds – 7/7 that are self-terminating and recurrent
2. Persistent - Episodes lasting > 7/7
3. Permanent - Fails to terminate using cardioversion, or that is terminated but relapses w/in 24 hrs, or longstanding AF in which cardioversion has not been indicated or attempted

Question 2

Signs and Symptoms:

Answer 2

1. Asymptomatic
2. Breathlessness
3. Dyspnoea
4. Palpitations
5. Syncope/Dizziness
6. Chest discomfort
7. Stroke/TIA

Question 3

Causes:

Answer 3

1. IHD
2. Valvular Heart Disease
3. HTN
4. Hyperthyroidism
5. Drugs e.g. bronchodilators, caffeine, alcohol
6. Infection
7. Electrolyte depletion
8. DM
9. Other cardiac conditions e.g. WPW syndrome, pericarditis etc.

Question 4

CHA₂DS₂-VASc Atrial Fibrillation Risk Score:

Answer 4

1. Congestive Heart Failure (CCF) - 1
2. Hypertension - 1
3. Age >=75 - 2
4. Age 65-74 - 1
5. Diabetes - 1
6. Stroke/TIA/thrombo-embolism - 2
7. Vascular disease - 1
8. Sex – female - 1

Question 5

Mx- Haemodynamically unstable?

Answer 5

1. PERI-ARREST Call
2. Urgent Cardiology review
3. Consider DCCV

Question 6

Mx - Haemodynamically stable <24 hours:

Answer 6

1. Treat reversible causes

Question 7

Mx - Haemodynamically stable >24 hours or don’t know:

Answer 7

1. Cardiology R/V:
   Consider DC or chemical cardioversion with:
   Amiodarone mg/kg IV 1hr via central vein OR
   Flecainide mg/kg Iv over 20 minutes if structural hart disease
2. CHADSVASC + HASBLED score
3. Rate control:

Bisoprolol 2.5 – 10mg PO
Metoprolol 50 – 100mg PO
Digoxin 500mcg PO (loading)

4. Refer to cardiology & consider oral anticoagulation:

Medway patient – refer for arrhythmia clinic

Swale patient – AEC within 2 weeks and discuss with cardio for cardiology clinic