AF Flashcards
What are the modifiable and non-modifiable risk factors for arrhythmia?
modifiable
- hypertension, obesity, sleep apnea, diabetes, thyroid problems, exposure to stimulants, stress
non-modifiable
- age, male sex, congenital heart defects, family history
What are symptoms of arrhythmias?
palpitations
dyspnoea
fatigue
weakness
poor exercise tolerance
irregular pulse
dizziness
chest pain
anxiety
What are the types of pharmacological treatments for arrhythmias? What is the different between them?
rate control
- beta blockers, calcium channel blockers, digoxin, amiodarone
- controls heart rate but does not address cardiac arrhythmia
rhythm control
- beta blockers, flecainide, amiodarone, electrical ablation with amiodarone
- re-establishes normal sinus rhythm and synchronises atrial/ventricular contraction
Who is rhythm control better for?
new onset AF
HF thought to be primarily caused by worsened by AF
AF with reversible causes (chest infection)
rhythm control strategy is better suited based on clinical judgement
- younger patients, disabled patients
atrial flutter
- more suited for ablation therapy
What are the first, second and third lines of rate control therapy? What are they suited towards?
- beta blockers (NOT sotalol)
= thyrotoxicosis, post myocardial infarction - calcium channel blockers (NOT with reduced LVEF)
= bronchospasm - digoxin (ONLY for non-paroxysmal AF)
= sedentary lifestyle (activity reduces efficacy)
How does choice of beta blockers differ in patients with AF? What are the side effects of beta blockers?
people with AF only
- atenolol, bisoprolol
people with HF
- bisoprolol, carvedilol, nebivolol
people with diabetes
- cardio selective beta blocker such as atenolol. bisoprolol
side effects
- bradycardia, cold extremities, sleep disturbance, nightmares, sexual dysfunction
What are the side effect and contraindications/cautions for calcium channel blockers?
side effects
- bradycardia, vasodilatory adverse effects, GI disorders, constipation (verapamil), dizziness (diltiazem)
contraindications/cautions
- congestive heart failure, severe hypotension, pregnant women
What are the side effects, contraindication, cautions and drug interactions for digoxin?
side effects
- cardiac effects
- digoxin toxicity
= confusion, loss of appetite, nausea, vomiting, diarrhoea, visual changes
cautions
- hypokalaemia, renal impairment, elderly people
interactions
- TCAs, diuretics, St Johns Wort, amiodarone, calcium channel blockers, spironolactone
What are the treatments for rhythm control?
beta blockers
pill in pocket
- flecainide (Na channel blocker)
- propafenone
= if paraoxysmal
dronedarone
amiodarone
electrical ablation with amiodarone
What are the side effect associated with amiodarone?
nausea, vomiting, diarrhoea
- common with loading doses but resolve with dose reduction
neurological symptoms
- tremor, ataxia
What are the tests used to calculate risk of stroke?
CHA2DS2VASc
- congestive heart failure
- hypertension
- age > 75 years
- diabetes
- stroke/TIA
- vascular disease
- age 65-74 years
- sex (female)
ORBIT
- old age, > 75 years
- reduced haemoglobin <13mg/dl (men) or <12mg.dl (women)
- bleeding history
- insufficient kidney function
- treatment with anti platelet agent
Why should monotherapy aspirin not be given solely for stroke prevention in AF?
due to slow moving blood caused by AF
- blood clots are mainly made up of fibrin not platelets
= require anti-coagulants
How should stroke be treated?
anticoagulants
- direct oral anticoagulants = apixaban, edoxaban, rivaroxaban, dabigatran
- vitamin K antagonist = warfarin
What are advantages and disadvantages of using DOAC and Vitamin K antagonists to treat stroke?
DOAC
- no INR monitoring needed, standardised dosing and dose adjustments, less food-drug interactions
- require modification in renal impairment, not all have reversal agents available
Vitamin K antagonists
- reversal agents available
- INR monitoring is required, variable dosing, many drug-food interactions, teratogenic
