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PHAM01 > Wk 12: Atrial fibrillation > Flashcards

Wk 12: Atrial fibrillation Flashcards

1
Q

Define atrial fibrillation

A

Supraventricular tachyarrhythmia

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2
Q

What is the ventricular rate of untreated AF?

A

160-180 bpm

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3
Q

Define paroxysmal AF

A
  • Lasts longer than 30 secs + less than 7 days
  • Self terminating + recurrent
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4
Q

Define persistent AF

A
  • Lasts longer than 7 days
  • Or less than 7 days but requires cardioversion
  • Spontaneous termination unlikely to occur
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5
Q

Define permanent AF

A
  • Fails to terminate using cardioversion
  • Terminated but relapses w/in 24 hrs
  • > 1 year where cardioversion = not indicated or attempted
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6
Q

What are the cardiac causes of AF?

A
  • Congestive HF
  • Atrial/ventricular hypertrophy
  • Wolf-parkinson-white syndrome
  • Pericarditis
  • Myocarditis
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7
Q

What are the non-cardiac causes of AF?

A
  • Acute infection
  • Diabetes
  • Electrolyte depletion
  • Cancer
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8
Q

Which medications cause AF?

A
  • Thyroxine
  • Bronchodilators
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9
Q

What are the complications of AF?

A
  • x5 risk of stroke + thromboembolism
  • HF
  • Tachycardia-induced cardiomyopathy
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10
Q

What are the main symptoms of AF?

A
  • Breathlessness
  • Palpitations
  • Chest discomfort
  • Syncope
  • Stroke
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11
Q

How is the diagnosis of AF carried out?

A
  • Manual pulse palpation for irregular pulse
  • 12 lead ECG
  • 24 hr ambulatory ECG if paroxysmal AF suspected
  • Echocardiography
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12
Q

Give examples of other differential diagnosis

A
  • Atrial flutter: saw tooth pattern of regular atrial activation
  • Sinus tachy: >100bpm
  • Supraventricular tachycardias
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13
Q

What is used to treat arrhythmias?

A
  • Rate control
  • Rhythm control
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14
Q

What is used in rate control?

A
  • Beta blockers
  • CCB (diltiazem or verapamil)
  • Digoxin if v little exercise + options are ruled out
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15
Q

What is rhythm control and who is it for?

A

Cardioversion:

  • New onset AF (<48hrs)
  • Reversible cause (infection)
  • HF caused/worsened by AF
  • Atrial flutter for ablation
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16
Q

What is offered for new onset AF who will be treated by rhythm control?

A
  • Pharmacological Cardioversion
  • Anticoagulation
  • Bleed risk
17
Q

What is given for pharmacological cardioversion?

A
  • Flecainide or amiodarone if not evidence of structural/ischaemic
    HD
  • Amiodarone if evidence of structural HD
  • > 48hrs/uncertain, delay cardioversion til maintained on anticoagulant for 3 wks. Offer rate control
18
Q

When do you avoid beta blockers?

A

History of obstructive airway disease

19
Q

Which beta blockers are used for lone AF?

A

Atenolol

  • 50-100mg daily
  • Monitor HR + BP
20
Q

Which beta blocker is used for AF w/ Hx MI?

A
  • Metoprolol
  • Propranolol
  • Atenolol
21
Q

Which beta blocker is used for AF w/ Hx HF?

A
  • Bisoprolol
  • Carvedilol
  • Nebivolol
22
Q

What are the adverse effects of beta blockers?

A
  • Bradycardia + hypotension
  • Cold extremities
  • Hypo/hyperglycemia in diabetes
  • W/drawal effect
  • Fatigue
23
Q

Which CCBs are used in AF?

A

Diltiazem + verapamil

24
Q

What are the interactions of CCBs?

A
  • Simvastatin: cap at 20mg
  • Avoid in HF: depress cardiac function + worsens symptoms (use amlodipine)
25
Q

What are the side effects of CCBs?

A
  • Headache
  • Dizziness
  • Hypotension
  • Bradycardia
26
Q

What is flecainide used for?

A
  • Infrequent paroxysms + symptom induced by known precipitants

Paroxysmal AF:
- No Hx of LV dysfunction/valvular/IHD

  • Hx infrequent symptomatic episodes
  • SBP >100 + resting HR >70bpm
27
Q

What is used to assess stroke risk?

A

CHA2DS2-VASc

28
Q

what is used to assess bleeding risk + when is it used?

A

ORBIT

  • Starting anticoagulant
  • Reviewing anticoagulant
29
Q

When do you offer/consider anticoagulation in AF?

A
  • CHA2DS2-VASc of 2+
  • Men w/ 1 score
30
Q

What are used for anticoagulation in AF?

A
  • Apixaban, dabigatran, edoxaban + rivaroxaban
  • CI DOACs: vit K antagonist, if already on warfarin, switch treatment
31
Q

Which patients are not offered anticoagulation?

A

<65 w/ AF + no risk factors other than gender

32
Q

What happens if a patient is not taking anticoagulants?

A
  • Review at 65
  • Review if develops: diabetes, HF, atrial disease, coronary HD, stroke, ischaemic attack or thromboembolism
33
Q

Which anticoagulation is used for new onset AF?

A

Heparin until anticoagulation started

34
Q

In a confirmed AF diagnosis, onset <48hrs, when would you offer an oral anticoagulation?

A
  • Stable sinus rhythm not restored w/in same 48hrs
  • High risk of AF recurrence (failed cardioversion, structural HD + prolonged AF)
  • Based on CHADSc-VASc

PHAM01 (47 decks)

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