Palpitations

Question 1

Risk factors of atrial fibrillation

Answer 1

age, HTN, obesity, diabetes, heart failure, IHD, hyperthyroidism, CKD, alcohol overuse, smoking

Question 2

What causes AF?

Answer 2

heart conditions (HTN, atherosclerosis, valve disease, congenital heart disease, cardiomyopathy, pericarditis)
medical conditions (overactive thyroid gland, pneumonia, asthma, COPD, lung cancer, T2DM, PE, CO poisoning)

Question 3

how to diagnose AF

Answer 3

check pulse= irregularly irregular
ECG: absent P wave, rapid QRS complex
ECHO
CXRAY

Question 4

What is CHA2DS2VAsc and what are its’ categories?

Answer 4

=atrial fibrillation stroke risk calculation:
C: congestive heart failure (1point)
H: hypertension (1 point)
A: age (75+) (2 points)
D: diabetes (1 point)
S: stroke (2 points)
V: vascular disease (1 point)
A: age (65-74) (1 point)
SC:Sex Category (female) (1 point)

Question 5

What is ORBIT and what are its’ catagories?

Answer 5

=bleeding risk score for AF
Age (75+) (1 point)
Reduced Hb (<13mg/dL) (2 points)
Bleeding history (2 points)
Insufficient kidney function (eGFR<60mg/dL) (1 point)
Treatment with anti platelet agent (1 point)

Question 6

What is HASBLED and what is its’ catagoreis?

Answer 6

=score for major bleeding risk
H: hypertension
A: abnormal renal/ liver function
S: stroke
B: bleeding tendency
L: labile INR
A: age > 65
D: drugs (NSAIDs)

Question 7

How do you calculate regular heart rhythm on an ECG?

Answer 7

• count the number of large squares in one R-R
• divide 300 by this number = heart rate

Question 8

how do you calculate irregular heart rhythm on a ECG?

Answer 8

-count the number of complexes on the rhythm strip (10 seconds long)
-multiply this by 6

Question 9

What does an absent p wave suggest?

Answer 9

AF

Question 10

What does a prolonged PR interval suggest?

Answer 10

AV delay = 1st degree heart block (occurs between SA node and AV node)

Question 11

What are the two types of second degree heart block and what do they look like on an ECG?

Answer 11

=some p waves conduct and others don’t
Mobitz 1 block: progressive PR interval (occurs IN AV node)
Mobitz 2 block: QRS interval is dropped (occurs AFTER AV node in bundle of His)

Question 12

What is third degree heart block?

Answer 12

No electrical communication between atria and ventricles

Question 13

What is the treatment of AF and their side effects?

Answer 13

BB: SOB, tiredness, cold hands, low BP, ankle swelling
ACEI: dry cough, fatigue, dizziness, headache
digoxin: nausea, vomiting, diarrhoea
Cardioversion DC shock: need to give LMWH to minimise thromboembolism