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Hugh's MD2 Core Conditions and Presentations > AF > Flashcards

Flashcards in AF Deck (19):
1

Which drugs are used for rate control?

Digoxin

Beta blockers - Metoprolol, atenolol

Non-dihydropyridine calcium channel blockers

 

2

Which drugs are used for rhythm control in AF?

Flecainide

Sotalol

Amiodarone

Digoxin

3

What is an important side effect of sotalol?

Prolonged QT interval

4

When is flecainide contraindicated?

In IHD and structural heart disease due to risk of arhythmias

5

What is the mechanism of action of amiodarone?

Na+ and Ca+ blocker

And beta-blocker

Increases the refractory period

6

What are some side effects of amiodarone?

Liver - elevated LFTs

Lung - pulmonary fibrosis

- Pneumonitis

Skin - Blue/gray discolouration

- photosensitivity

Eye - Corneal microdeposits

Hyper or hypo thyroidism

7

What are some non-pharmacological interventions for rhythm control?

Cardioversion

Pulmonary vein catheter ablation

8

What are the novel oral anticoagulants?

Rivaroxaban

Apixiban

Dabigatran

9

What are the "three P's" that are used to describe the different natural histories of AF?

Paroxysmal - Abrupt onset, revert spontaneously within 24-48 hours

Persistent - Abrupt onset, can persist for weeks to months if definitive intervention isn't undertaken

Permanent - Refractive to treatment

10

Which drugs should be avoided if AF is coexistent with HF?

Flecainide

Sotalol

11

What is optimal, rate or rhythm control (and anticoagulation for both) in patients with chronic or persistent AF?

There is no morbidity or mortality benefit for one over the other

(2002,  AFFIRM trial)

12

What are the principles of management of a patient with new onset paroxysmal AF (<48)?

- Reversion to sinus rhythm is preferred

- Anti-coagulation is added while this is done to prevent thrombus formation

- Flecainide (2mg/Kg IV over 30mins) or amiodarone (5mg/kg over 20mins)

- Electrical cardioversion is performed if spontaneous or pharmacological reversion fails

13

What are the principles of management of a patient with rapid AF of >48 hours duration?

- Risk of thromboembolism is significant therefore rate control is prefered to reversion in the acute setting (unless the symptoms are severe)

Rate control:

- Oral metoprolol, diltiazem, or verapamil if not severe

- IV metoprolol, verapamil, or esmolol +/- MgSO4 if more unstable

 

14

What is the best option for treatment of new AF in the setting of WPW?

DC cardioversion

 

Flecainide or Amiodarone are the prefered drugs

15

What are the three "S's" of approaching a patient in AF?

Symptoms

Systolic function

Stroke risk

16

How do you approach the Ix and management of AF?

Ix

- 12 lead ECG

- UEC, CMP

- Troponins 

- TTE

 

Mx 

- Rate vs Rhythm control

- ?Anticoagulation

- Targets K > 4, Mg > 1

- Ix for cause

 

17

How do you dose therapeutic clexane?  How long do you place a bridging dose for?

1mg/kg bd, adjusted for renal function

3 days

18

What is the normal target INR? What about for mechanical valves?

2-3,

2.5-3.5

19

Outline the CHA2DS2VASc score

C - CCF

H - HTN

A - Age >75 = 2 points

D - DM

S - Stroke/TIA Hx = 2 points

V = Vascular disease

A = Age 65-74

Sc = Sex, female = 1