Palpitations (A.fib)

Question 1

Aetiology (PIRATES)

Answer 1

PuLmonary: PE and COPD
Ischaemic heart disease
Rheumatic fever: Valvular abnormality
Anaemia, Alcohol, Advancing Age
Thyroid disease: hyperthyroidism
Electrolyte disturbances: hypo/hyperkalaemia
Sepsis and sleep apnoea

Question 2

Risk factor

Answer 2

60+
T2DM
HTN
Hyperthyroidism
Congestive heart failure
Valve stenosis (Mitral stenosis)
Dietary: Smoking, Excessive caffeine or alcohol consumption
Medication - salbutamol, atropine, decongestants (e.g. pseudoephedrine)
Recreational drug use: cocaine, and metenephrines

Question 3

Diagnosis

Answer 3

First line and gold standard: ECG
- absent P waves
- chaotic baseline
- irregular ventricular rate
- ventricular rate 160-180 Bpm
- ventricular complexes look normal unless there is a ventricular conduction defect
If paroxysmal AF is suspected = 24 hour ambulatory ECG
- KardiaMobile
- Serum electrolytes
- TFTs
- Cardiac bio markers
- CXR
- Transthoracic ECHO

Question 4

Complications

Answer 4

Stoke
Myocardial infarction
Heart failure
Reduced quality of life

Question 5

CHA2DS2-VAsc score

Answer 5

C = congestive heart failure/LV function
H = hypertension
A2 = Age > 75
D = diabetes mellitus
S2 = Stroke/TIA/thromboembolism
V = vascular disease
A = age = 65-74
S = sex (female)
Max score is 9
Verify risk of stroke in patients with A.fib

Question 6

ORBIT score

Answer 6

Older age = 1
Reduced haemoglobin/ Hct/ anaemia = 2
Bleeding history = 2
Insufficient kidney function = 1
Treatment with anti platelets = 1

Estimates the risk of a major bleeding for patients on anticoagulants for A.fib