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MBChB3 > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

What are the symptoms of AF?

A
  • asymptomatic
  • palpitations
  • dyspnoea
  • rarely chest pain, syncope
  • may present with complications eg. Stroke
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2
Q

How can a diagnosis be made of AF?

A

Irregularly irregular pulse (confirmed by ECG)

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3
Q

What are the different types of AF?

A
  • paroxysmal
  • persistent (requires intervention to terminate)
  • permanent
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4
Q

What are the ECG signs of AF?

A
  • rate variable
  • no p-waves
  • regular narrow QRS
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5
Q

What are the signs of atrial flutter on ECG?

A
  • saw-tooth pattern of p-waves
  • regular narrow QRS
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6
Q

What are the objectives of AF treatment?

A
  • prevention of stroke
  • symptom relief
  • optimum management of associated CVD
  • rate control (target = <110/min or <80/min)
  • with/without rhythm disturbance
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7
Q

What are the essential investigations for AF?

A
  • ECG + echo to confirm diagnosis
  • TFTs and LFTs
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8
Q

What are the rate control drugs used in AF?

A
  • BB eg. Atenolol
  • rate-limiting Ca2+ antagonist eg. Verapamil
  • digoxin (second-line)
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9
Q

What are the major risk factors for a stroke in AF?

A
  • previous stroke
  • TIA/systemic embolism
  • age >75
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10
Q

What are the non-major risk factors for stroke in AF?

A
  • CHF
  • hypertension
  • diabetes
  • vascular disease
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11
Q

How is stroke risk measured in patients?

A

CHA2DS2-VASc scoring system (if 2+ score, give anticoagulation)

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12
Q

What category of patients will require specialist assessment for AF?

A
  • patients still symptomatic despite adequate rate control
  • young <60
  • inadequate rate control despite BB/Ca2+ antagonist + digoxin
  • structural heart disease on echocardiogram
  • AF and coexisting HF
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13
Q

What therapy is used for rhythm management in AF?

A
  • direct current cardioversion (persistent)
  • anti-arrhythmic drugs
  • catheter ablation
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14
Q

What anti-arrhythmic drugs are used in AF?

A
  • Class I Na+ channel blockers eg. Flecainide
  • Class III K+ channel blockers (prolong AP/QT interval) eg. Sotalol, amiodarone
  • multi-channel blockers eg. Dronedarone
  • all often used in combination with BB
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15
Q

Describe catheter ablation in treatment of AF

A
  • destroying the tissue responsible for putting the electrical signal off-course
  • identifies triggers of AF in pulmonary veins
  • veins radio-frequency current or cryo-ablation
  • more effective in structurally normal hearts/minimal heart disease
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16
Q

What patients are referred for catheter ablation?

A
  • highly symptomatic paroxysmal AF resistant to 1+ anti-arrhythmic drugs and little/no co-morbidity
  • symptomatic AF and LVSD with reduced EF
  • highly symptomatic persistent AF
  • typical atrial flutter

MBChB3 (100 decks)

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