Management of AF

Question 1

What type of tachycardia is AF?

Answer 1

Supraventricular

Question 2

What are the common causes of AF?

Answer 2

Excessive alcohol consumption
CHD
Thyrotoxicosis

Question 3

50% of AF cases are asymptomatic. What are some of the symptoms that AF patients may present with?

Answer 3

Syncope
Dyspnoea
Half notice palpitations

Question 4

Patients with AF are 5 times more likely to have a stroke. True or false?

Answer 4

True

Question 5

What is meant by a lone AF?

Answer 5

Single episode
Structurally normal heart
Low risk of thromboembolic event

Question 6

What is meant by paroxysmal AF?

Answer 6

Spontaneous termination within 7 days

Question 7

What is meant by persistent AF?

Answer 7

Non-self terminating and is persistent for over 7 days

Question 8

What is meant by permanent AF?

Answer 8

Non-terminated or terminated and relapsed

Question 9

How long does acute AF last for?

Answer 9

Less than 48 hours

Question 10

How is paroxysmal AF treated?

Answer 10

B-blocker or rate limiting CCB

Question 11

What is the aim of treatment in paroxysmal AF?

Answer 11

Reduce frequency of self-limiting episodes
Prevent the occurrence
Control ventricular rate during episodes

Question 12

What is the aim for treatment of persistent/permanent AF?

Answer 12

Heart rate control

Question 13

What is first line treatment given for persistent/permanent AF?

Answer 13

B-blocker or rate limiting CCB

Question 14

What is given for treatment of persistent/permanent AF if monotherapy doesn’t work?

Answer 14

Two of either beta blocker, digoxin, diltiazem

Question 15

If dual therapy doesn’t work in treatment of persistent/permanent AF, aim of treatment should become controlling rate. True or false?

Answer 15

False - should move on from controlling rate to controlling rhythm

Question 16

What is cardioversion?

Answer 16

Involves an electrical shock into chest wall to override conduction pathways and allow sinus nodes to control HR again

Question 17

Cardioversion is used to control heart rate. True or false?

Answer 17

False - used for rhythm control

Question 18

All patients are successfully cardioverted on their first attempt. True or false?

Answer 18

False - 80%

Question 19

If patient re-lapses after cardioversion, what treatment is given?

Answer 19

Long-term B blocker

Question 20

Can digoxin cardiovert?

Answer 20

No, it controls heart rate not rhythm

Question 21

Photosensitivity and skin discolouration are common side effects of which drug?

Answer 21

Amiodarone

Question 22

Amiodarone converts the heart back to sinus rhythm. True or false?

Answer 22

True

Question 23

Amiodarone interacts with digoxin and which other drug?

Answer 23

Warfarin

Question 24

What is the CHA2DS2VASc risk assessment used for?

Answer 24

To assess risk for use of anti-coagulant in treatment of AF

Question 25

Should patients with a CHA2DS2VASc risk score of >2 be anticoagulated?

Answer 25

Yes

Question 26

Should anti-coagulation be considered for male patients with a CHA2DS2VASc risk score of 1?

Answer 26

Yes

Question 27

What is the HAS-BLED score used for?

Answer 27

Once CHA2DS2VASc risk has been established, risk assess bleeding risk for patient who need anti-coagulation

Question 28

What HAS-BLED score indicates a risk of bleeding and what does this mean?

Answer 28

>3 - does not disqualify use of anticoagulants but use with caution

Question 29

What does INR stand for?

Answer 29

International normalised ratio - blood test to see how long blood takes to clot

Question 30

How long is the onset of warfarin?

Answer 30

2-3 days

Question 31

What is the normal INR value?

Answer 31

1

Question 32

What is the target INR is AF patient?

Answer 32

2.5

Question 33

How do laxatives interact with warfarin?

Answer 33

They reduce warfarin absorption

Question 34

What does a high INR mean?

Answer 34

Blood takes a long time to clot and so increased risk of haemorrhage

Question 35

What does a low INR mean?

Answer 35

Blood clots quickly and so increased risk of thromboembolic events

Question 36

What is the result of the interaction between warfarin and metronidazole?

Answer 36

Reduced warfarin metabolism and so enhanced effects of warfarin

Question 37

Vitamin K interferes with warfarin. True or false?

Answer 37

True

Question 38

Patients should be counselled if they take warfarin. What should they be told?

Answer 38

Tell all practitioners they are on warfarin Reduce alcohol Diet - Vit K Bring yellow book to appointments

Question 39

What colour is a 1mg tablet of warfarin?

Answer 39

Brown

Question 40

What colour is a 3mg tablet of warfarin?

Answer 40

Blue

Question 41

What colour is a 5mg tablet of warfarin?

Answer 41

Pink