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AF and stroke Flashcards

1
Q

who is AF common in?

A

age >55

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2
Q

what are the symptoms of AF?

A

breathlessness, palpitations, chest discomfort, fatigue, reduced exercise tolerance, dizziness

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3
Q

what is paroxysmal AF?

A

self-limiting episodes lasting no more than 7 days

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4
Q

what are the underlying causes of AF?

A

high BP, hyperthyroidism, heart valve disease, ischemic heart disease

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5
Q

what is suggestive of poor coagulation?

A

2 INR levels higher than 5 OR 1 INR level higher than 8 in the past 6 months

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6
Q

emergency treatment for acute AF life threatening headmodynamic disability?

A

emergency electrical cardioversion to achieve anticoagulation

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7
Q

emergency treatment for acute AF NOT life threatening?

A

give rate or rhythm control if onset is less than 48hr but if onset is more than 48hours or uncertain give rate control

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8
Q

what is pharmacological cardio version?

A

IV amiodarone or flecainide

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9
Q

rate control is preferred first line treatment except when…..

A
  • AF is new onset
  • Atrial flutter suitable for ablation strategy
  • AF with reversible cause
  • Rhythm control is more suitable
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10
Q

what drugs are used in the pill in the pocket strategy?

A

flecainide and propafenone

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11
Q

what 2 processes are involved in destruction of neuronal cells?

A

apoptosis - occurs within 1 hour

necrosis - occurs within 6 hours

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12
Q

initial management of stroke?

A

alteplase - within 4.5hrs
aspirin - 300mg for 14 days (start within 24hrs)
assess swallowing ability

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13
Q

long term anti-platelet management for stroke?

A

ischaemic stroke -clopidogrel 75md OD

TIA - MR dipyridamole 200mg BD AND aspirin 75mg OD

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14
Q

when is anticoagulant treatment given for stroke and TIA pts?

A

stroke - delay treatment for 2 weeks

TIA - start immediately

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15
Q

what are the 4 common underlying causes of AF?

A

high BP, ischaemic heart disease, heart valve disease, hyperthyroidism

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16
Q

what does the LVEF have to be before giving dabigatran and when can you give it to above 65+?

A

less than 40% and 65 or older with one of the following; DM, coronary artery disease, HTN

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17
Q

what can contribute to poor anti-coagulation control?

A

illness, interacting drugs, lifestyle factors, cognitive function

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18
Q

when would you consider left appendage atrial occlusion (LAAO)?

A

consider this if anti-coagulation is contraindicated or not tolerated

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19
Q

why would you not consider digoxin?

A

only if patient is sedentary as it doesnt work on exertion

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20
Q

what would be initial rate control monotherapy?

A

BB (other than sotalol) or CCB

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21
Q

who should you NOT offer flecainide and propafenone?

A

to people with known ischaemic or structural heart disease

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22
Q

who should the pill in the pocket strategy be considered for?

A

those who have no history of LVD, or valvular or ischaemic heart disease and have a hx of infrequent symptomatic episodes of paroxysmal AF and have a systolic blood pressure greater than 100 mmHg and a resting heart rate above 70 bpm and are able to understand how to, and when to, take the medication.

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23
Q

how would you reduce risk of postoperative AF?

A

amiodarone, standard beta blocker (not sotalol) and rate-limiting CCB

24
Q

advantages of NOAC?

A
  • efficacy and safety appear similar to warfarin
  • rapid onset of action
  • does NOT require INR monitoring
  • fewer drug interactions
25
what is an embolic stroke?
blood clot that blocks the cerebral artery and originates outside the brain
26
what can TIA be defined as?
temporary episodes of cerebral ischaemia
27
what are the major symptoms of stroke?
FAST
28
how can some patients recover from the sensory deficits caused by stroke?
undamaged neurones sprout new branches into the damaged area and aid in the recovering lost function
29
how does hypoxia affection overreaction of glutamate and aspartate receptors?
hypoxia - over reaction of glutamate and asparate receptors, result in opening of certain receptors including NMDA - subsequent membrane depolarisation causes influx of Ca, Na and Cl ions and efflux of potassium ions. - Intracellular Ca increases proteases, lipases and endonucleases which causes destruction of cell structures.
30
the region affected by severe ischaemia is called?
core zone
31
the patient may find difficulties in speaking and understanding speech and may get confused between left and right. - which area of the brain is affected?
wernicke's area of the cerebrum
32
how would you diagnose stroke/TIA?
Computerized tomography (CT), MRI (can detect changes within minutes)
33
what tool is used to commonly distinguish between ischaemic and hemorrhagic strokes?
CT
34
for initial management what should be considered for patients being transferred home before 14 days?
Patents who are transferred home before 14 days should switch from: asprin 300mg to clopidogrel 75mg
35
when should anticoagulation not be given for long term management of stroke?
in uncontrolled HTN or until brain imaging hasnt ruled out haemorrhagic stroke
36
what should be given to patients if pts have prev dyspepsia associated with aspirin
aspirin + PPI
37
in apoptosis what process occurs later?
breakdown of integrity of plasma and mitochondrial membrane
38
major causes of IDA?
inadaquate iron absorption, increased physiological demand, GI bleeding
39
treatment of IDA
ferrous sulphate 200mg BD/TDS - takes between 1-2 weeks for Hb level to rise - continue up to 3 months after levels return to normal to replenish stores
40
what should you give if ferrous sulphate is not tolerated?
ferrous gluconate, ferrous fumarate
41
parenteral iron options
IRON DEXTRAN, IRON SUCROSE, FERRIC CARBOXYMALTOSE, IRON ISOMALTOSIDE
42
what serum ferritin levels confirms diagnosis?
less than 15mcg/L
43
why is the onset of b12 deficiency delayed?
Onset of anaemia is delayed because the body has 2-3mg of stores which is sufficient for 2-3 years
44
treatment for vitamin b12 defiency?
IM hydroxycobalamin 1mg 3 times a week for 2 weeks then 1mg every 3 months where there is neurological involvement give 1mg on alternate days for 2 weeks then 1mg every 2 months
45
what is the cell size and cell colour in iron deficiency anaemia?
SMALL cell size and PALE colour
46
mechanism of bile acid sequestrants
hepatic conversion of cholesterol to bile acids
47
example of a fibrate
gemfibrozil
48
symptoms of b12 deficiency
Mild thrombocytopenia, spleen slightly enlarged, mild jaundice, slow insidious onset, progressive neuropathy affective legs – tingling in feet and loss of vibration sense (feature separating it from other anaemias)
49
what should you consider if pharmacological cardioversion is agreed?
A choice of flecainide or amiodarone to people with no evidence of structural or ischaemic heart disease or amiodarone to people with evidence of structural heart disease.
50
In people with atrial fibrillation in whom the duration of the arrhythmia is greater than 48 hours or uncertain and considered for long‑term rhythm control, delay cardioversion until what?
they have been maintained on therapeutic anticoagulation for a minimum of 3 weeks. During this period offer rate control as appropriate.
51
when is dronedarone recommended?
option for the maintenance of sinus rhythm after successful cardioversion in people with paroxysmal or persistent atrial fibrillation
52
if drug treatment for long term rhythm control is needed what is recommended as first line?
beta blocker other than sotalol
53
if monotherapy with a standard beta blocker is not successful as a rate control strategy what would you recommend?
combination therapy with digoxin, diltiazem, beta blocker
54
which drug should you avoid in heart failure and LV dysfunction?
CCB and dronedarone
55
with anticoagulant for stroke prevention would you give if left ventricular ejection fraction below 40%?
dabigatran

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