Management of AF Flashcards
What type of tachycardia is AF?
Supraventricular
What are the common causes of AF?
Excessive alcohol consumption
CHD
Thyrotoxicosis
50% of AF cases are asymptomatic. What are some of the symptoms that AF patients may present with?
Syncope
Dyspnoea
Half notice palpitations
Patients with AF are 5 times more likely to have a stroke. True or false?
True
What is meant by a lone AF?
Single episode
Structurally normal heart
Low risk of thromboembolic event
What is meant by paroxysmal AF?
Spontaneous termination within 7 days
What is meant by persistent AF?
Non-self terminating and is persistent for over 7 days
What is meant by permanent AF?
Non-terminated or terminated and relapsed
How long does acute AF last for?
Less than 48 hours
How is paroxysmal AF treated?
B-blocker or rate limiting CCB
What is the aim of treatment in paroxysmal AF?
Reduce frequency of self-limiting episodes
Prevent the occurrence
Control ventricular rate during episodes
What is the aim for treatment of persistent/permanent AF?
Heart rate control
What is first line treatment given for persistent/permanent AF?
B-blocker or rate limiting CCB
What is given for treatment of persistent/permanent AF if monotherapy doesn’t work?
Two of either beta blocker, digoxin, diltiazem
If dual therapy doesn’t work in treatment of persistent/permanent AF, aim of treatment should become controlling rate. True or false?
False - should move on from controlling rate to controlling rhythm
What is cardioversion?
Involves an electrical shock into chest wall to override conduction pathways and allow sinus nodes to control HR again
Cardioversion is used to control heart rate. True or false?
False - used for rhythm control
All patients are successfully cardioverted on their first attempt. True or false?
False - 80%
If patient re-lapses after cardioversion, what treatment is given?
Long-term B blocker
Can digoxin cardiovert?
No, it controls heart rate not rhythm
Photosensitivity and skin discolouration are common side effects of which drug?
Amiodarone
Amiodarone converts the heart back to sinus rhythm. True or false?
True
Amiodarone interacts with digoxin and which other drug?
Warfarin
What is the CHA2DS2VASc risk assessment used for?
To assess risk for use of anti-coagulant in treatment of AF
Should patients with a CHA2DS2VASc risk score of >2 be anticoagulated?
Yes
Should anti-coagulation be considered for male patients with a CHA2DS2VASc risk score of 1?
Yes
What is the HAS-BLED score used for?
Once CHA2DS2VASc risk has been established, risk assess bleeding risk for patient who need anti-coagulation
What HAS-BLED score indicates a risk of bleeding and what does this mean?
> 3 - does not disqualify use of anticoagulants but use with caution
What does INR stand for?
International normalised ratio - blood test to see how long blood takes to clot
How long is the onset of warfarin?
2-3 days
What is the normal INR value?
1
What is the target INR is AF patient?
2.5
How do laxatives interact with warfarin?
They reduce warfarin absorption
What does a high INR mean?
Blood takes a long time to clot and so increased risk of haemorrhage
What does a low INR mean?
Blood clots quickly and so increased risk of thromboembolic events
What is the result of the interaction between warfarin and metronidazole?
Reduced warfarin metabolism and so enhanced effects of warfarin
Vitamin K interferes with warfarin. True or false?
True
Patients should be counselled if they take warfarin. What should they be told?
Tell all practitioners they are on warfarin
Reduce alcohol
Diet - Vit K
Bring yellow book to appointments
What colour is a 1mg tablet of warfarin?
Brown
What colour is a 3mg tablet of warfarin?
Blue
What colour is a 5mg tablet of warfarin?
Pink
