Unit 6 - Cardiovascular - AF & Stroke Flashcards
What is digoxin monotherapy used for?
People with non-paroxysmal AF who are sedentary
Which people is digoxin monotherapy contraindicated for?
People who do a lot of exercise
- heart rate can’t go high enough
What is cardioversion?
Delivery of a direct countershock to the heart synchronized to the QRS complex
When should cardioversion be used?
Recommended in some people with new-onset AF
- within 48 hours of presentation
- especially with reversible cause
- in heart failure worsened by AF or atrial flutter
Give examples of types of cardioversion used in specialist care
Pharmacological cardioversion
Electrical cardioversion
Surgical cardioversion
Give examples of a drug that is useful for paroxysmal AF cardioversion
Flecainide - class Ic antiarrhythmic - IV loaded then oral dosing Amiodarone - class III antiarrhythmic - 200 mg TDS x 7, BD x 7, OD
What are the adverse effects of flecainide used in cardioversion?
- asthenia
- dizziness
- dyspnoea
- fatigue
- fever
- oedema
- pro-arrhythmic effects
- visual disturbances
- drug interactions
What is the problem of amiodarone as a treatment for AF?
Very long half life
- 3 - 6 months after stopping meds
Interacts with lots of other medications
What is electrical cardioversion?
Similar to external defibrillation Patient sedated for a short period of time Electric shock treatment Takes 5 - 10 minutes Instant improvement Take temperature and pulse ECG Anticoagulant needed
When is surgery used as a treatment for AF?
Used when medication isn’t tolerated or effective
What is catheter ablation?
Normally carried out via a vein in the groin
- sometimes wrist
Area of heart causing abnormal electrical discharges destroyed with radiofrequency energy or cryotherapy
- if this is the AV node, a pacemaker will be used in advance to restore sinus rhythm
How can strokes be caused?
Stagnation of blood in atria and incomplete ventricular emptying leads to clot formation Risk of embolism to the brain Risk of stroke increases - 5 x is non-rheumatic AF - 17 x in rheumatic (valvular) AF
More than 20% of strokes in the UK are attributable to AF
What is the second most common cause of death?
Stroke
What is the third most common loss of disability-adjusted life years?
Stroke
How does the prevalence of stroke change with age?
Increases