Unit 6 - Cardiovascular - AF & Stroke

Question 1

What is digoxin monotherapy used for?

Answer 1

People with non-paroxysmal AF who are sedentary

Question 2

Which people is digoxin monotherapy contraindicated for?

Answer 2

People who do a lot of exercise

- heart rate can’t go high enough

Question 3

What is cardioversion?

Answer 3

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

Question 4

When should cardioversion be used?

Answer 4

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

Question 5

Give examples of types of cardioversion used in specialist care

Answer 5

Pharmacological cardioversion
Electrical cardioversion
Surgical cardioversion

Question 6

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

Answer 6

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

Question 7

What are the adverse effects of flecainide used in cardioversion?

Answer 7

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

Question 8

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

Answer 8

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

Question 9

What is electrical cardioversion?

Answer 9

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

Question 10

When is surgery used as a treatment for AF?

Answer 10

Used when medication isn’t tolerated or effective

Question 11

What is catheter ablation?

Answer 11

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

Question 12

How can strokes be caused?

Answer 12

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

Question 13

What is the second most common cause of death?

Answer 13

Stroke

Question 14

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

Answer 14

Stroke

Question 15

How does the prevalence of stroke change with age?

Answer 15

Increases

Question 16

What is a stroke?

Answer 16

Sudden onset focal neurological deficiency

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

Question 17

What are the symptoms of a stroke?

Answer 17

Slurred speech

Limb weakness

Question 18

How does AF cause a stroke?

Answer 18

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

Question 19

How else are strokes caused?

Answer 19

Atherosclerosis

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

Small vessel disease
- hypertension