AF Flashcards
(19 cards)
What is AF?
A tachydysrythmia where there is uncoordinated atrial activity
Paroxysmal AF is
AF terminates spontaneously within 7 days of onset (often 48hrs)
What is persistent AF?
AF present for 7 days or more, terminated by cardioversion
Permanent AF
AF which is accepted without attempted cardioversion or cannot be terminated
What might trigger episodes in AF?
Ectopic activity at or near the pulmonary vein ostia in left atrium
Why does AF cause a prothrombin state?
- Structural & functional changes along with blood stasis.2. Damage to the myocardium causes expression of prothrombic factors on the endothelial surface of the atria, activation of platelets and inflammatory cells leads to clot formation. Even short episodes increase risk
What happens in AF?
Abnormal electrical impulses start firing in the atria and override the atrioventricular node. Can’t control hearts rhythm, results in irregular and often abnormally rapid ventricular rhythm.
What is the most common risk factor for AF?
Hypertension
List other health conditions that increase the liklihood of AF
Heart failure with reduced ejection fracture. Atrial or ventricular dilation or hypertrophy, congenital heart disease, amyloidosis, pericarditis, ischaemia heart disease, valvular heart disease.
Which non cardiac conditions are associated with increased risk?
PE, pneumonia, COPD, CKD, thyrotoxicosis, hypokaleimia, hyponatremia, cancer, diabetes
Which lifestyle factors increase risk?
Increasing age, alcohol excess, smoking, Medications (lithium, thyroxine), obesity, vigorous physical activity, higher in men
Nmonic
Pirates PE, Ischaemia, resp disease, atrial enlargement, thyroid disease, ethanol, sepsis, sleep apnoea
What are key points in the history of someone presenting with AF? Symptoms
Breathlessness, palpitations, fatigue, tiredness, dizziness, chest tightness or pain, syncope, sleep disturbance
What are key factors in a person’s past medical history for AF?
History of hypertension, stroke, TIA
What are key signs on physical examination of AF?
Irregular Pulse (radial and at the apex), might be very slow or fast, regular Pulse makes AF less likely, assess for signs of haemodynamic instability (tachycardia, 150bpm plus, hypotension systolic BP less than 90, severe dizziness, syncope/loc, ischaemia chest pain, acute pulmonary oedema) auscultation for murmur (valvular heart disease) , examine lungs for pulmonary oedema, other signs of HR
Which investigations would you use for AF?
12 lead ECG
Other investigations depend on underlying cause-FBC, TFTs, hbA1C, lipids, urea, electrolytes, renal function, LFTs, xchest x Ray if lung pathology is suspected, echo if suspect structural heart disease.
What signs are you likely to see on an ecg?
Absence of distinct repeating p waves, irregularly irregular r-r intervals, narrow QRS complex.
