AF

Question 1

How do you identify Left Ventricular Hypertrophy on an ECG?

Answer 1

• very tall R waves
• ST depression
• Over 3 leads

Question 2

What are signature AF ECG landmarks?

Answer 2

Absence of P waves

-Irregularly irregular

Question 3

What are the three types of AF?

Answer 3

paroxysmal, persistent or permanent

Question 4

What is paroxysmal AF usually associated with?

Answer 4

normal hearts

Question 5

What is chronic AF usually associated with?

Answer 5

heart disease

Question 6

What are the characteristics of sustained AF?

Answer 6

It is facilitated by increased parasympathetic tone.

• decreased refractory periods
• shorter wave lengths
• making it easier for AF to sustain itself

Question 7

What is the mechanism of AF?

Answer 7

• Atria is firing away rapidly
• muscle layer in atrium is often diseased
• caused by multiple wavelets of re-entry

Question 8

How do we stop AF?

Answer 8

• electrical cardioversion (technique where deliver high voltage across the atria to reset the rhythm to voltage 0 of action potential)
• anti arrythmatic drugs

Question 9

What are the characteristics of paroxysmal AF?

Answer 9

• paroxysmal and lasting less than 48 hours

- often recurrent

Question 10

What are the characteristics of persistent AF?

Answer 10

• an episode of AF lasting more than 48hours, which can still be cardioverted to NSR
• unlikely to spontaneously revert back to NSR

Question 11

What are the characteristics of permanent AF?

Answer 11

-inability to restore NSR

Question 12

What are some of the associated diseases/causes of AF?

Answer 12

-hypertension
-congestive heart failure
-CHD
-obesity
Thyroid disease
-Genetic
-cardiac valve disease

Question 13

What is Lone (idiopathic) AF

Answer 13

Absence of any heart disease and no evidence of ventricular dysfunction
essentially dont know what causes it

Question 14

What are the symptoms of AF?

Answer 14

• palpitations
• pre syncope
• syncope
• chest pain
• dyspnoea
• sweatiness
• fatigue
• asymptomatic

Question 15

How does AF look on an ECG?

Answer 15

• fast atrial rate
• irregularly irregular
• absence of P waves
• Presence of f waves

Question 16

What is the ventricular rate dependant on in AF?

Answer 16

• Av node conduction properties
• sympathetic and parasympathetic tone
• presence of drugs which act on the AV node

Question 17

What are some abnormal patterns of AF?

Answer 17

Alow VR rate with periods of fast VR. A pacemaker may be needed to allow control of fast VR. It could result in complete heart block
-treat with pacemaker and B blocker

Question 18

What is pseudo-regularisation AF?

Answer 18

a fake regular heart rate AF

Question 19

What are some important points to consider about AF?

Answer 19

• decreased diastole leads to reduced CO
• can result in congestive HF especially in diastolic dysfunction
• VR less than 60 suggest AV conduction disease

Question 20

What are the management options for AF?

Answer 20

• rhythm control or rate control
• anti-coagulation for both approaches if high risk for thromboembolism
• manage risk and symptoms

Question 21

What are the treatment options to slow down AV node conduction and therefore slow rate in AF ?

Answer 21

digoxin, B blockers, verapamil, diltilazem

-use these drugs alone or in combination

Question 22

What are the treatment options to revert AF to sinus rhythm?

Answer 22

• antiarrythmatic drugs

- direct current cardioversion

Question 23

What are the treatment options to maintain normal sinus rhythm?

Answer 23

• anti-arrythmatic drugs
• catheter ablation of atrial focus/ pulmonary veins
• surgery

Question 24

What are the four classes of antiarrhythmatic drugs?

Answer 24

1, 2, 3 ,4

Question 25

What is a class 1 anti- arrythmatic drug?

Answer 25

- reducing Na channel current | - Lignocaine, quinidine, felcainide, propadenone

Question 26

What is a class II ant arrythmatic drug?

Answer 26

- adrenergic antagonists | - propanolol

Question 27

What is a class III anti arrythmatic drug?

Answer 27

- action potential prolongation | - aminodarone, sotalol, dronedarone

Question 28

What is a class IV anti arrythmatic drug?

Answer 28

- ca channel antagonists | - verapamil

Question 29

what puts you at a high risk of thromboembolism?

Answer 29

- valvular heart disease - age above 75 especially if female - hypertension - heart failure - previous thromboembolism or stroke - CAD or diabetes and above 50y/old - Thyrotoxicosis

Question 30

Should you have any of risk factors for thromboembolic disease then what medication should you be on?

Answer 30

Anticoagulants ie warfarin, rivaroxaban

Question 31

What are indications for anticoagulation in valvular AF?

Answer 31

-mitral valve disease: Mitral Stenosis and Mitral regurgitation

Question 32

What are indications for anticoagulation in non valvular AF?

Answer 32

- age above 75 - hypertension - HF - previous stoke/thromboembolism - CAD/DM - Diabetes

Question 33

What is indicated by a 1 or 2 on the CHA2DS2-VASc score?

Answer 33

1- anticoagulation should be considered | 2-they should be on anticoagulation

Question 34

when would radiofrequency ablation in AF be used?

Answer 34

- To maintain SR by ablating AF focus | - For rate control by ablation of the AV node to stop fast conduction to the ventricles

Question 35

What is an atrial flutter?

Answer 35

-regular and regular form of atrial tachycardia -usually paroxysmal -sustained by a macro-re-entrant circuit -circuit is confined to the rigtht atrium -episodes can last from seconds to years -chronic atrial flutter usually progresses to atrial fibrillation May result in thromboembolism

Question 36

What are the characteristics on an ECG in atrial flutter?

Answer 36

- atrial 300bpm - ventricular rate usually half that - saw tooth P wave pattern - normal QRS - normal conduction sometimes 2:1 - regular rhythm but may be variable

Question 37

What are the treatment options for atrial flutter?

Answer 37

-radiofrequency ablation -pharmacological therapy -cardioversion warfarin for thromboembolic prevention

Question 38

What are the two goals in atrial flutter?

Answer 38

- -Terminate the flutter and prevent recurrence | - Control the ventricular response during the arrhythmia

Question 39

What are the pharmacological therapies used in AF in aim of?

Answer 39

- slow the Ventricular rate - restore sinus rhythm - maintain sinus rhythm once converted