Unit 6 - Cardiovascular - AF & Stroke Flashcards

1
Q

What is digoxin monotherapy used for?

A

People with non-paroxysmal AF who are sedentary

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2
Q

Which people is digoxin monotherapy contraindicated for?

A

People who do a lot of exercise

- heart rate can’t go high enough

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3
Q

What is cardioversion?

A

Delivery of a direct countershock to the heart synchronized to the QRS complex

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4
Q

When should cardioversion be used?

A

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
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5
Q

Give examples of types of cardioversion used in specialist care

A

Pharmacological cardioversion
Electrical cardioversion
Surgical cardioversion

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6
Q

Give examples of a drug that is useful for paroxysmal AF cardioversion

A
Flecainide
- class Ic antiarrhythmic
- IV loaded then oral dosing
Amiodarone
- class III antiarrhythmic
- 200 mg TDS x 7, BD x 7, OD
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7
Q

What are the adverse effects of flecainide used in cardioversion?

A
  • asthenia
  • dizziness
  • dyspnoea
  • fatigue
  • fever
  • oedema
  • pro-arrhythmic effects
  • visual disturbances
  • drug interactions
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8
Q

What is the problem of amiodarone as a treatment for AF?

A

Very long half life
- 3 - 6 months after stopping meds
Interacts with lots of other medications

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9
Q

What is electrical cardioversion?

A
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
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10
Q

When is surgery used as a treatment for AF?

A

Used when medication isn’t tolerated or effective

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11
Q

What is catheter ablation?

A

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

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12
Q

How can strokes be caused?

A
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

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13
Q

What is the second most common cause of death?

A

Stroke

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14
Q

What is the third most common loss of disability-adjusted life years?

A

Stroke

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15
Q

How does the prevalence of stroke change with age?

A

Increases

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16
Q

What is a stroke?

A

Sudden onset focal neurological deficiency

  • interruption of blood flow to the brain
  • structural abnormalities or blockage of blood
17
Q

What are the symptoms of a stroke?

A

Slurred speech

Limb weakness

18
Q

How does AF cause a stroke?

A
Turbulent blood in atrium
Static blood
- atria not contracting and sending blood to ventricles
Clot forms
Left atrial appendage
Clot released
Clot lodges in the brain vessels
Stroke
19
Q

How else are strokes caused?

A

Atherosclerosis

  • hardening of the arteries
  • carotid arteries in the neck
  • imaging/scan
  • useful for warning signs

Small vessel disease
- hypertension