CASE STUDY 2: AF and Digoxin

Question 1

What is atrial fibrillation and what causes it ? What is a potentioal complication of untreated AF ?

Answer 1

Condition that causes an irregular and often fast heartbeat usually caused by hypertension, obesity excess alcohol.

Cardiac cells become different/diseased causing atria to fibrillate

Since the heart cannot pump blood sufficiently out of the heart, blood clots form which can then circulate in the bloodstream and travel to the brain where it can get stuck in arteries and cause a stoke or get stuck in the arteries near the heart causing heart-attacks

Question 2

What are the symptoms of AF ?

Answer 2

Dizziness
Shortness of breath
Tiredness/fatigue due to less effective blood delivery
Heart palpitations
Chest discomfort
stroke
TIA

Question 3

What is digoxin and what is it used for ?

Answer 3

Cardiac glycoside

Used to treat heart problems such as irregular heart beats in AF

It works by reducing heart rate but will not get the rhythm back to normal as other medications such as amiodarone is used to do this

Question 4

What makes someone eligible for treatment of digoxin for AF even though it is not often recommended as fists line treatment for AF ?

Answer 4

• Patient does little to no exercise as it is not effective in people who do regular exercise
• if patients cannot tolerate other medications used to treat AF

Question 5

As well as digoxin, what other medications should a patient suffering from AF be put on ?

Answer 5

Beta blocker- Bisoprolol
Or
Calcium channel blocker-Diazepam

To help reduce the heat rate to less than 90 beats per minute at resting

Question 6

What tools can be used to calculate risk of stroke and bleeding ?

Answer 6

CHA₂DS₂-VASc Score for Atrial Fibrillation Stroke Risk

ORBIT score used to assess patients risk of bleeding

Question 7

what is the difference betwen ‘on palpitation’ and ‘on auscultation”

Answer 7

auscultation= listening to the heart typically with a stethoscope
Palpitation = feeling the body with fingers and hands

Question 8

what is the difference between ‘on palpitation’ and ‘on auscultation”

Answer 8

auscultation= listening to the heart typically with a stethoscope
Palpitation = feeling the body with fingers and hands

Question 9

In AF what is the typical heart rate that people have ?

Answer 9

• Between 100bpm and 175bpm
• Some people with have a normal heart rate ranging between 60-100bpm and still be experiencing AF.
• This is very rare but can happen

Question 10

What are the risk factors of AF

Answer 10

CV disease eg hypertension, coronary artery disease, vascular disease
Obesity
Diabetes
Excess alcohol
Genetics

Question 11

How would AF be diagnosed ?

Answer 11

ECG reading where the HCP would identify any irregular pulses or abnormalities between the QRS complex

This is also known as atrium twitching

Question 12

What tools can be used to calculate stroke risk and risk of bleeding in patients ?

Answer 12

Orbit score for risk of bleeding
CHA2DS2-VASc- for risk of stroke

Question 13

when should digoxin be given as treatment for af ?

Answer 13

When the patient has permanent af and does little to no exercise

Question 14

True or false
an anticoagulant such as Apixiban should NOT be given to someone whilst taking digoxin

Answer 14

False,
Anticoagulants should be considered to be used alongside digoxin
this will reduce the risk of strokes and heart attacks

Question 15

Is digoxin effective in people who do a lot of exercise ? what alternatives could be given to these patients ?

Answer 15

Not as effective
Beta blockers or a calcium channel blocker can be used as first line treatment for AF in these patients

Question 16

Why is digoxin a hight risk drug ?

Answer 16

Difficult to use due to its:
1. Narrow therapeutic window
2. Toxicity issues