Atrial Fibrillation Flashcards
Atrial fibrillation
Arrhythmia characterised by an irregularly irregular rhythm, which is a result of is characterised by uncoordinated atrial activity on the surface ECG, with fibrillatory waves of varying shapes, amplitudes, and timing associated with an irregularly irregular ventricular response when atrioventricular (AV) conduction is intac
Different classifications of Atrial Fibrillation (5)
Paroxysmal AF lasts <7 days
Persistent AF lasts >7 days
Long Standing Persistent AF lasts >1 year in duration
Permanent Atrial Fibrillation refractory to cardioversion and sinus rhythm cannot be restored or maintained
Non-Valvular Atrial Fibrillation absence of rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair.
Common causes for paroxysmal AF (3)
Infection
Exacerbation of Heart failure
Post MI
Thyrotoxicosis
Risk factors for AF
Age Diabetes HTN CHF CAD Hyperthyroidism Other atrial arrhythmia
Signs and symptoms of newly onset AF
Risk factors Irregularly irregular Hypotension Elevated JVP Added heart sound
Treatment for Haemodynamically unstable AF
Direct current conversion
Treatment for Haemodynamically stable AF with left atrial thrombus
No heart failure:
B Blocker and or CCB (rate control)
Anti-coagulation
Cardioversion
Heart failure:
Digoxin or Amiodarone (rate control)
Anti-coagulation
Cardioversion
Treatment for Haemodynamically stable AF without left atrial thrombus
No heart failure CHA2DS2-VASc 0-1:
B Blocker and or CCB (rate control)
Cardioversion
No heart failure CHA2DS2-VASc >2:
B Blocker and or CCB (rate control)
Cardioversion + Heparin
Heart failure:
Digoxin or Amiodarone (rate control)
Anti-coagulation
Cardioversion + Heparin
Cardioversion drugs (5)
Flecainide Propafenone Amiodarone Dronedarone Ibutilide Sotalol
Causes of chronic AF (6)
All types of cardiac disease Thyroid disease Autonomic neuronal dysfunction Alcohol and caffeine abuse Non-cardiac pulmonary hypertension Infections.
Strong risk factors for chronic AF (5)
hypertension coronary artery disease congestive heart failure advancing age diabetes mellitus rheumatic valvular disease alcohol abuse male sex presence of other arrhythmias smoking
CHA2DS2-VASc
Congestive heart failure 1 Hypertension 1 Age ≥ 75 2 Age 65-74 1 Diabetes mellitus 1 Stroke/TIA/thrombo-embolism 2 Vascular disease 1 Sex Female 1
What is CHA2DS2-VASc?
Calculation for risk of stroke in AF patients
What is the recommendation for anti-coagulation based on the score?
0 = “low” risk. Doesn’t require anti-coagulation
1 = “low-moderate” risk. Consider anti-platelet or anti-coagulation
>2= “moderate-high” risk. Anticoagulation candidate.
(Remember for females, they automatically get 1 for being female so 1 is low risk)
