W24 Arrhythmia Flashcards

1
Q

what is the most common form of arrhythmia

A

artial fibrillation

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2
Q

what is disorganisation of atrial depolarisation

A

electrical and mechanical remodelling of the atrial

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3
Q

what is the pathophysiology of arrhythmia

A
structural and congential heart disease
ischaemic heart disease 
obesity
advancing age
excess stimulant use
uncontrolled hypertension
hyperthyroidism
associated with most chronic diseases
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4
Q

what are the consequences of atrial fibrilation

A

increases risk of stroke by 5 fold

af strokes are usually more debilitating / disabiling than strokes not caused by atrial fibrilation

uncontrolled atrial fibrilation can lead to congestive heart failure

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5
Q

what are the goals of treatment of arrhythmia

A

relieve symptoms

prevent thromboembolic complications

  • proven mortality benefit
  • bleeding risk
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6
Q

what is the progression of atrial fibrilation

A

disordered contraction in atria cause it to quiver

overrides the sinus node stimulus

usually started as paroxysmal events

repeated paroxysms = additional stress on the atria
- progressive fibrosis and scarring from this stress atrial dilation.

over time usually develops into persistent atrial fibrilation

if persists for > 1 year it is considered permanent atrial fibrilation.

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7
Q

what are the symptoms of a stroke

A

facial weakness
arm weakness
speach issues
time

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8
Q

how is atrial fibrilation diagnosed

A

pulse check

ECG to confirm

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9
Q

what are some potential causes of atrial fibrilation

A
hyperthyroidism
pulmonary embolus
anaesthesia 
electrolyte disturbance
alchohol binge
sepsis
stimulant drug use
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10
Q

what is the referal criteria

A

refer all those with irregular pulse to GP asap

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11
Q

when should a patient be sent to to emergency services

A
haemodynamic instability
stroke
heart failure
PE
thyrotoxicosis
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12
Q

what are the symptoms of atrial fibrilation

A
palpitations
breathlessness
syncope
dizziness
chest pain and discomfort
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13
Q

what events may prompt for investigation for atrial fibrilation

A

stroke or TIA

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14
Q

how do we identify risks when dealing with atrial fibrilation

A

CHADSVASC

2 or more - anticoagulation

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15
Q

what are the two main treatment options of atrial fibrilation

A

Rate

Rhythm

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16
Q

when is rhythm control considered

A

patients who remain symptomatic despite adequate rate control therapy

those with infrequent but symptomatic episodes of paroxysmal AF

new onset AF where a reversible cause is likely

those whose heart failure is thought to be caused by AF

those with haemodynamic instability

17
Q

what are the advantages of rate control

A

therapeutically convenient

less exposure to drug toxicity

optimal rate control adequate to decrease hospitalisation

cost effective

18
Q

what are the disadvantages of rate control

A

no effect on disease progression

may not be beneficial in highly symptomatic patients

19
Q

what are the advantages of rhytm control

A

prevents disease progression

avoids unfavourable electrical and structural remodelling

potentially preferable in younger patients

better quality of life

20
Q

what are the disadvantages of rhytm control

A

exposure to adverse effects of antiarrhytmic drugs

generally less cost effective

21
Q

what is the first line of rate control

A

beta blocker (licensed option)

rate limiting calcium channel blocker

22
Q

2nd line of rate control

A

digoxin monotherapy only for sedentary patients

23
Q

what is the choice between first and 2nd line

A

co morbidities and critieria changes for different ages

24
Q

what pharmacological items can be used in rhym control

A

if <48 hours duration anti arrhymtic drugs can be used

25
what are some example antiarrhythmic drugs
sotalol amiodarone flecainide propafenone
26
what are non pharmacological approaches to control rhythm
Direct current cardioversion DCCV electrical reset to try and get heart to go back into SR Increased success rate whe ncombined with antiarrhythmic treatment before and continued for 6 weeks after if 48 hours duration
27
what are the side effects of treating atrial fibrilation
anticoagulation haemorrhage rate control - bradycardia if over treated - hypotension for some drugs - other drug specific options rhythm control - amiodarone loads of side effects
28
what si the difference between anti platelet vs anticoagulant
arterial clots = antiplatelet platelet rich clot treated with aspirin and clopidogrel venous clots fibrin rich clot treated with warfarin