Week 10 - AF + treatment

Question 1

Name the risk factors associated with AF

Answer 1

Cardiac RF

• HyperTension

IHD ( ischaemic heart disease)

• Structural heart disease

Non cardiac

• Diabetes
• COPD
• Increased alcohol intake
• thyroidtoxicoasis

Question 2

Describe the pathophysiologyy of AF and the three types of AF

Answer 2

• Irregualar rapid atrial rate ( 300-600bpm)
• Acute <48hr
• Chronic > 48hr
  Paroxysmal - intermittant AF
  Persistant - PErsistant AF ( long standing but converted treatment)
  Permanant- Fasiled to respond to treatment

Question 3

Describe the further pathophysiology of AF

Answer 3

• The stasis of blood in the atria increases predisposioion of cerebrel and sytemic thromboembolism
• Slow atrial blood flow partially actibvation clotting cascade

V rate = 100-180bpm

Question 4

Describe the ECG presentation of AF

Answer 4

No P wave present with fibrilation waves

Question 5

What are the symptoms of AF

Answer 5

SOB
Dizziness
fatigue
palpitations

noticed via complication already present

• heart failure
• angina
• thromboembolism

Question 6

What are the three areas managed in nice management of AF

Answer 6

• Stroke prevention
• Rate control
• Rhythm control

Question 7

Describe the nice guidelines stroke prevention in AF

Answer 7

• Stroke risk assessed

Stroke risk score to consider anticoagulation therapy
- Criteria ( Men >1) ( women >2)

• Blood risk assessed

Orbit score used to assess risk of bleeding who are starting or have started anticoagulayion therapy

Question 8

Name the anticoagulation drugs used in stroke prevention

Answer 8

First line - DOACS
- APixaban
- EDoxaban
- Rivaroxiban
- Dabigatran

**Warfarin **

Question 9

Describe the rate control management according to nice guideline

Answer 9

• Standard B blocker ( bisoprolol )
• Rate limiting calcium channel blocker ( verapamil , diltiazem )

Digoxin - only if sedentary lifestyle

If mono-therapy not responding then B bloker + either calcium rate limiting blocker/ Digoxin

Question 10

What are the rhythm control first line management

Answer 10

• Electrical cardioversion

Drug therapy

1st- B blocker

• Dronederone
• Amioderone ( if Heart failure)

Question 11

What treatment is given for paroxysmal (PAF) and what drug should be cautioned in PAF

Answer 11

( Flecainide) - treats attacks controls rate + rhythm

Antithrombotic

Digoxin CANNOT as this increases and persists the paroxysmals

Question 12

What treatment is given if all AF treatments are rejected

Answer 12

• Left atrial ablation
• Ablation in the left atrium where arrhyhtmia orioginates

-Pace and ablate

Ablation of AV node + pacemaker