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AF Flashcards

1
Q

What is atrial fibrillation?

A

Atrial fibrillation is the most common sustained cardiac arrhythmia, characterised by irregular ventricular pulse and a loss of coordination between the cardiac apex and radial pulsation

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2
Q

What are the consequences of developing AF?

A
  • Stagnation of blood in the atria leading to thrombus formation and a risk of embolism, increasing stroke risk
  • Reduction in cardiac output (especially during exercise) which may lead to heart failure
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3
Q

What are the different types of AF?

A 
Acute 
Paroxysmal 
Recurrent 
Persistent 
Permanent
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4
Q

What is acute AF?

A

onset within 48 hours

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5
Q

What is paroxysmal AF?

A

spontaneously termination within 7 days, mainly in 24 hours

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6
Q

What is recurrent AF?

A

2 or more episodes (can be permanent or paroxysmal)

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7
Q

What is persistent AF?

A

non-self termination lasting longer than 7 days

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8
Q

What is permanent AF?

A

long standing AF lasting over a year which is not successful terminated by cardioversion or may relapse

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9
Q

What are the causes of AF?

A

cardiac causes
non cardiac causes
lifestyle

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10
Q

What are the cardiac causes of AF?

A 
coronary artery disease 
hypertension 
valvular defects 
CHD 
cardiomyopathy
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11
Q

What are the non cardiac causes of AF?

A 
hypertension 
acute infection 
drugs 
DM 
PE
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12
Q

What are the lifestyle causes of AF?

A

alcohol binging
excess caffeine intake
obesity

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13
Q

How can AF present?

A 
irregular manual pulse 
breathlessness 
palpitation 
syncope and dizziness 
chest discomfort 
stroke/TIA
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14
Q

What investigations should be carried out when suspecting AF?

A

ECG should be performed in all people
Blood tests
CXR
Echocardiogram

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15
Q

Is an ECG diagnostic?

A 
o Diagnostic (except in paroxysmal between attacks)
o A 24 hour ambulatory ECG in paroxysmal AF if asymptomatic episodes suspected or episodes less than 24 hours apart
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16
Q

Which blood tests should be ordered?

A

o TFTs, FBC, U&E, LFTs, coagulation screen

  • Hyperthyroidism is a reversible cause
  • Anaemia may precipitate HF
  • Electrolyte disturbance may potentiate arrhythmia
  • Coagulation screen before anticoagulation initiated
17
Q

Why should a CXR be carried out?

A

to identify any underlying structural causes of AF

18
Q

Why should an echocardiogram be carried out?

A
  • can identify any underlying heart problems

- before cardioverison

19
Q

What are the main principles of managing AF?

A

control of arrhythmia by rate and rhythm and thromboprophylaxis

treat any underlying cause - infection, hyperthyroidism

treat any associated heart failure

20
Q

What is the first line strategy in managing AF?

A

rate and rhythm control

consider unless AF had a reversible cause, new onset AF, heart failure due to AF

21
Q

How is rate managed?

A

Beta blocker or rate limiting calcium channel blocker as monotherapy

consider digoxin if non-paroxysmal AF in sedentary patients

if monotherapy unsuccessful consider combination therapy

22
Q

How is rhythm managed in those with symptoms or rate control is unsuccessful?

A

if stable with pharmacological - amiodarone or electrical conversion

electrical conversion in an emergency

23
Q

What is the CHA2D2-VASc score used to calculate?

A

the risk of stroke

24
Q

When is treatment indicated in the CHA2D2-VASc score?

A

score of two or more requires treatment

25
Q

What treatment is used in CHA2D2-VASc score of 2 or more?

A

1 or more of warfarin, dabigatran, apixaban, riboroxivan

26
Q

What scoring system is used to indicate bleeding risk before initiating antcoagualtion?

A

HAS-BLED

27
Q

What are the risk factors listed in CHAD-VAS?

A 
C - congestive heart failure 
H - hypertension 
A - age (+2)
D - diabetes 
S - stroke/TIA Hx (2 points) 
V - vascular disease 
A - age (65-74) 
S - sex (female)

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