Tachyarrhythmias

Question 1

Risk factors for AF?

Answer 1

1) HTN

2) IHD

3) Valvular heart disease (especially mitral disease)

4) Pulmonary diseases

5) Thyroid disease

6) Alcohol - ‘holiday heart’ after alcohol binge

7) Caffeine

8) Advanced age

9) Acute illness

Question 2

What symptoms may be seen in AF?

Answer 2

1) Palpitations

2) SOB (due to HF)

3) Dizziness (due to reduced cardiac output)

4) Chest pain (due to impaired filling of coronary arteries)

Question 3

What signs may be seen in AF?

Answer 3

1) Irregular pulse

2) Hypotension

3) HF (as heart tries to compensate for ineffective beating)

Question 4

Key complications of AF?

Answer 4

1) Stroke

2) Reduced cardiac output

3) HF

Question 5

Investigations in AF?

Answer 5

1) ECG

2) Bloods: FBC (anaemia, infection), U&Es (electrolytes and renal function), TFTs (thyrotoxicosis)

3) If acute - VBG

4) CXR

5) Echo (valves & LV size/function)

6) Troponin? CTPA? D-dimer?

7) 24h ECG if suspected paroxysmal AF

Question 6

Mx of unstable AF?

Answer 6

Manage as tachyarrhythmia –> DC cardioversion +/- amiodarone

Question 7

Mx of stable AF?

Answer 7

1) Treat underlying cause

2) Rate control e.g. beta blocker

3) Rhythm control e.g. cardioversion, amiodarone/flecainide

4) Manage stroke risk - CHADs-VASc2 risk vs bleeding risk