Unit 6 - Cardiovascular - AF

Question 1

What is an ECG?

Answer 1

Electrocardiogram

Question 2

What is sinus rhythm?

Answer 2

A normal heart beat

- starts at sinoatrial node (SAN)

Question 3

What is an arrhythmia?

Answer 3

Abnormal rate and/or rhythm of heart beat

Question 4

What is tachycardia?

Answer 4

Abnormally fast heart rate

Question 5

What is bradycardia?

Answer 5

Abnormally slow heart rate

Question 6

What is the normal resting heart rate?

Answer 6

60 - 100 bpm

Question 7

Give examples of common arrhythmias

Answer 7

Ectopic beats
Atrial fibrillation (AF)
Atrial flutter
Ventricular tachycardia
Ventricular fibrillation

Question 8

What are ectopic beats?

Answer 8

Caused by impulse starting somewhere other than SAN or ventricles ignoring the impulse
- common or usually harmless

Question 9

What is Atrial Fibrillation (AF)?

Answer 9

Irregular and often abnormally fast heart rate

Most common sustained abnormal heart rhythm
- affects around 1 million people in the UK

Question 10

What is Atrial flutter?

Answer 10

Rapid atrial depolarization from an abnormal focus within the atria

Question 11

What is Ventricular Tachycardia (VT)?

Answer 11

Regular but fast heart rate

- can be caused by AF

Question 12

What is Ventricular fibrillation (VF)?

Answer 12

A ventricular arrhythmia in which a chaotic series of electrical impulses causes them to quiver ineffectively rather than contract smoothly

Question 13

What are the effects of ventricular fibrillation?

Answer 13

Most common life threatening arryhthmia

• cardiac arrest
• death

Question 14

How can ventricular fibrillation be treated?

Answer 14

Defibrillation

Question 15

How can atrial fibrillation be identified on an ECG?

Answer 15

Loss of P wave

- atria aren’t contracting as they should

Question 16

What are the four types of AF?

Answer 16

Paroxysmal AF
Persistent AF
Long-standing persistent AF
Permanent AF

Question 17

What is paroxysmal AF?

Answer 17

Episodes come and go

- usually stop within 48 hours without any treatment

Question 18

What is persistent AF?

Answer 18

Each episodes lasts for longer than seven days

- less when treated

Question 19

What is long-standing persistent AF?

Answer 19

Continuous AF for a year or longer

Question 20

What is permanent AF?

Answer 20

Present all the time

Question 21

What are the symptoms of AF?

Answer 21

Can be asymptomatic
- especially in older people
- first sign might be a stroke
Palpitations
Tiredness
Breathlessness/dyspnoea
Syncope/dizziness
Chest pain/discomfort

Question 22

What proportions of strokes are caused by undiagnosed AF?

Answer 22

AF suspected if someone has a stroke or TIA
- especially if no real reason
1/3 strokes caused by undiagnosed AF if no other cause

Question 23

What is the epidemiology of AF?

Answer 23

More commonly seen in older people
- around 7% of those over 65
More common in women
More likely in those with other conditions
- hypertension
- atherosclerosis
- heart valve issues
- heart failure
- diabetes

Question 24

What is the prognosis of those with AF?

Answer 24

Generally good with treatment
- not usually life-threatening on its own
- VF is!
Can cause heart failure as ventricles work too hard and enlarge
Can lead to stroke

Question 25

What are the goals of management of AF?

Answer 25

Establish the diagnosis of atrial fibrillation To control and prevent symptoms - by controlling ventricular rate or atrial rhythm To prevent stroke

Question 26

How can AF be diagnosed?

Answer 26

ECG - monitor pulse - can wear from 24 hours or a week to catch paroxysmal AF Chest x-ray

Question 27

What is the treatment for AF?

Answer 27

``` Admit to hospital if necessary - stroke - heart failure Identify and manage underlying causes and triggers - alcohol - stimulants - diabetes - lung condition/infection - dehydration Rate control - rate of ventricles beating Rhythm control - electrical rhythm Stroke prevention ```

Question 28

How can the rate of the heart be controlled to treat AF?

Answer 28

``` Recommended for most people - choice of drug class depends on co-morbidities and contraindications ``` Beta-blockers Rate-limiting calcium-channel blockers Digoxin monotherapy

Question 29

Give examples of beta-blockers that can be used to control heart rate in AF?

Answer 29

- atenolol - acebutolol - metoprolol - nadolol - oxprenolol - propranolol

Question 30

What are the adverse effects of using beta blockers to control heart rate in AF?

Answer 30

- bronchospasm - cold extremities - sleep disturbance/nightmares - fatigue - sexual dysfunction

Question 31

Give examples of calcium channel blockers that are used to control heart rate in AF?

Answer 31

- verapamil | - diltiazem

Question 32

What are the adverse effects of calcium channel blockers that are used to control heart rate in AF?

Answer 32

``` Dizziness Palpitations - ironic! GI disturbances Bradycardia Drug interactions ```