AFib

Question 1

Types of AF

Answer 1

Paroxysmal
Persistent
Permanent

Question 2

ECG findings

Answer 2

Absence of p waves
Fibrillatory waves in V1-3 or aVf
Irregularly irregular
170-180 bpm

Question 3

Exam findings

Answer 3

No A wave in JVP
Auscultation - no S4

Question 4

Causes

Answer 4

Pericarditis
PE or OSA
Ischemic heart disease or infarct
Rheumatic disease or other valvular pathology
Alcohol
Anemia
Thyrotoxicosis or toxins
Electrolytes
Sepsis

Question 5

What are the signs of instability in a pt, and what is the management?

Answer 5

Altered mentation, hypotension, cardiac ischemia, angina, decompensated HF
Sedation + synchronised cardioversion with 200J

Question 6

How to assess need for anticoagulation

Answer 6

CHAD65 score
> 65 y/o = use anticoagulation
< 65 y/o = any prior CHF, HTN, DM, Stroke or TIA = if yes, use anticoagulation
If none of these, check PAD or CAD = if yes, use antiplatelet like ASA or if already on ASA add clopidogrel
Take score, multiply by 2 = this is their yearly risk of stroke

Question 7

CHADS2Vasc score points

Answer 7

CHF = 1
HTN = 1
Age >65 = 1, >75 = 2
DM = 2
Stroke/ TIA/ PE/ DVT = 2
Vas (MI, CAD, PAD) = 1

Question 8

score to assess risk of bleeding from anticoagulation

Answer 8

HASBLED

Question 9

When is warfarin 1st line?

Answer 9

valvular AF

Question 10

Who needs rate control?

Answer 10

Symptomatic
Persistent AF should have HR <100
BB
Metoprolol IV 2.5-5mg now, repeat q15 mins x 2 until HR <100
HF - add digoxin as adjunct to BB
CAD - BB + CCB if further rate control needed
Sedentary - consider digoxin

Question 11

Indications for rhythm control

Answer 11

Highly symptomatic - angina CP
Persistent AF impacting function
Multiple recurrences
If AF is causing cardiomyopathy

Question 12

Method of cardioversion

Answer 12

If sx >24hrs, need to be anticoagulated x3 weeks before cardioverting
If <24hrs, can proceed immediately
If stable, use 100J

Question 13

Risks of cardioversion

Answer 13

May not work
Sedation can cause apnea
If conversion works, might not cause relief of sx

Question 14

Screening for AFib

Answer 14

check HR in all pts >65

Question 15

How long to anticoagulant after cardioversion?

Answer 15

4 wks

Question 16

How long to anticoagulant before cardioversion if high risk for a clot?

Answer 16

3 wks

Question 17

When to give rate control in AFib?

Answer 17

Older age, longstanding, asymptomatic

Question 18

When to give rhythm control in AFib?

Answer 18

Young, new diagnosis, symptomatic, no other comorbidities

Question 19

What tool to use for whether to give anticoagulant in AFib?

Answer 19

CCS CHADS-65 - CHF, HTN, Age 65+, DM, stroke/ TIA/ PE - if none of the above, do they have CAD? If yes - ASA

Question 20

When to use warfarin?

Answer 20

Valvular AFib