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Flashcards in 4 Stroke - AF Deck (24):
1

Why are we preventing stroke in people with AF?

-more likely to have stroke
-worse outcomes in stroke

2

How do we assess stroke risk in people with AF?

CHADS VASC

3

CHADS VASC score

CHF/LVD (+1)
Hypertension (+1)
Age >75 (+2)
Diabetes (+1)
Stroke/TIA history (+2)
Vascular disease (+1)
Age 65-75 (+1)
Sex - female (+1)

4

HASBLED scre

Hypertension (+1)
Abnromal renal/hepatic (+1 each)
Stroke (+1)
Bleeding (+1)
Labile INR (+1)
Elderly >65 (+1)
Drugs/alcohol (+1 each)

5

Should we use aspirin in AF?

no - it's ineffective at preventing strokes

6

Consider anti coagulation with CHADSVASc score over

1

7

Disadvantages of warfarin (4)

Narrow therapeutic window
Inconvenient INR testing
Interactions
Administrative burden to NHS

8

Advantages of Warfarin (3)

Cheap
Familliarity
Easily reversible

9

Advantages of Warfarin (3)

Cheap
Familliarity
Easily reversible

10

HASBLED scre

Hypertension SBP 65 (+1)
Drugs/alcohol - antiplatelets/more than 8 alcoholic drinks perweek (+1 each)

11

Advantages of Warfarin (3)

Cheap
Familliarity
Easily reversible

12

How do we use HASBLED and CHADSVASc?

If HASBLED is greater than CHADSVASc the risk of bleed outweighs the benifit of oral anticoagulants

13

When should you not anticoagulate someone with CHADsVASc =1

if it's 1 for being a woman

14

In ischamic stroke with AF when do we start anticoagulation?

And in TIA?

Use Asp 300mg OD until

14 days for disabling stroke
less if not disabling

For TIA begin immediately once hemorrhage is ruled out

15

AF symptoms

Lighteadedness
Palpitations
Syncope
Fatigue
Chest pain
SOB

16

What comes first - rate or rhythm control?

Rate

17

What comes first - rate or rhythm control?

Rate

18

What are the types of AF?

Permanent
Persistant - persists until cardioaversion
Paroxysmal - spontaneous end in 7 days

19

What is rate control strategy?

Monotherapy:
-B-blocker or RL-CCB
Dual therapy - any two of:
-B-blocker
-Diltiazem
-Digoxin

20

e.g. of RL -CCBs (2)

diltiazem and verapamil

21

Rhythm control strategy:

Cardioversion
Bisoprolol
Amiodarone
Flecainide or sotolol
Dronedarone?

22

How do b-blockers work?

They slow conduction through the AV node

23

How do b-blockers work?

They slow conduction through the AV node

24

CAUTION beta blockers are contraindicated with

Diltiazem