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Cardiology > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

What is the definition of Atrial fibrillation?

A

Disorganised electrical activity in the atria leads to irregular ventricular rhythm

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2
Q

What are common causes of Atrial Fibrillation?

(6)

A
  • S – Sepsis
  • M – Mitral valve pathology (stenosis or regurgitation)
  • I – Ischaemic heart disease
  • T – Thyrotoxicosis
  • H – Hypertension
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3
Q

What is the paroxysmal AF?

A

2 or more episodes, self terminating lasting <48 hours

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4
Q

Paroxysmal AF - Investigations

A

Patients with a normal ECG and suspected paroxysmal atrial fibrillation can have further investigations with:
* 24-hour ambulatory ECG (Holter monitor)
* Cardiac event recorder lasting 1-2 weeks

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5
Q

Paroxysmal AF - Management

A
  1. Flecainide - ‘Pill in pocket approach’
    Indication : infrequent episodes without structural heart disease
    * Pill taken when symptoms start
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6
Q

Valvular AF : Definition

A

AF with
* Significant mitral stenosis
* Mechanical heart valve
Assumed that valvular pathology has led to AF

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7
Q

Valvular AF : Management

A

Cardiologist referral

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8
Q

What is the definition of persistent AF?

A

continuous AF, lasting for >7 days

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9
Q

What are the symptoms of AF?

A
  1. Palpitation
  2. Dyspnoea
  3. Chest pain
  4. Syncope
  5. Irregularly irregular pulse
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10
Q

What are the ECG features of AF?

A
  • Absent P waves
  • Narrow QRS complex tachycardia
  • Irregularly irregular ventricular rhythm
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11
Q

What is the first line management of AF?

A

Rate control;
1. Beta blocker
or
Rate limiting calcium channel blocker
1. Combinition of non rate limiting CCB + Beta blocker

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12
Q

What is the management of Heart failure with Atrial Fibrillation?

A

Digoxin

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13
Q

What are the indications for rhythm control in AF?

(5)

A
  1. Haemodynamic instability secondary to AF
  2. AF with a reversible cause
  3. Heart failure primarily caused by AF
  4. New onset AF < 48 hours
  5. Atrial flutter whose condition is considered suitable for ablation strategy
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14
Q

What are the options for rhythm control?

A

Cardioversion
1. Immediate cardioversion if Sx onset < 48 hours
1. Electrical cardioversion
2. Chemical cardioversion
* Flecainide - no structural heart disease
* Amiodorone - structural heart disease

  1. Delayed Cardioversion
    1. Electric cardioversion after 3 weeks of anticoagulation
    2. Long-term rhythm control using medications
  • First-line : Beta blockers
  • Second-line - Dronedarone
    -for maintaining normal rhythm where patients have had successful cardioversion
  • Amiodarone is useful in patients with heart failure or left ventricular dysfunction
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15
Q

What is the management of a patient who presents <48 hours and clinically stable?

A
  • TOE and rhythm control (if suitable)
    Or
  • Rate control
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16
Q

What is the management of a patient who presents >48 hours and clinically stable?

A
  1. Rate control
    or
  2. If considered for rhythm control
    * 2. - 3 weeks minimum of anticoagulation prior to cardioversion
17
Q

What is the role of Flecainide in chemical cardioversion?

A
  • Indication : paroxysmal AF
  • Contraindication : cannot be used in patients with structural heart condition
18
Q

What is the role of Amiodorone in chemical cardioversion?

A

Indication : if coexisting HF

19
Q

Amiodorone : MOA

A

** Indication**
* class III antiarrhythmic agent
* used in the treatment of atrial, nodal and ventricular tachycardias.

MOA : blocking potassium channels which inhibits repolarisation and hence prolongs the action potential.

20
Q

What are the side effects of Amiodorone? (5)

A
  1. Photosensitivity
  2. Slate-grey pigmentation
  3. Hepatoxicity
  4. Hypo/Hyperthyroidism
  5. Pulmonary fibrosis
  6. Lengthening of the QT interval
  7. p450 inhibitor
  8. Thrombophlebitis at injection side
21
Q

Monitoring of Amiodorone

A
  • TFT, LFT, U&E, CXR prior to treatment
  • TFT, LFT every 6 months
22
Q

What is management of AF in a clinically unstable patient?

A
  1. Cardioversion
    * ECHO to r/o thrombus
    * AF has just started and no options to cardiovert - give IV amiodorone
23
Q

What does CHADSVASC stand for?

A
  1. C ongestive heart failure
  2. Hypertension
  3. Age > 75 years
    * 65 -74 years
  4. Diabetes
  5. Prior Stroke, TIA or Thromboembolism
  6. Vascular disease - Ischaemic heart disease and Peripheral arterial disease
  7. Sex (Female)
24
Q

What is the role of a CHADSVASC score?

(3)

A
  • Score >1 in males or >2 in females suggests need for anticoagulation
  • If CHASVASC suggests no need for anticoagulation - Transthoracic echo must be done to exclude valvular heart disease
  • Valvular heart diease is an absolute indication for anticoagulation
25
Q

What does ORBIT stand for?

A

Older age > 75 years
**R **educed haemoglobin/anaemia (Hb <130 or Hb <120 in females
Bleeding history
eGFR<60 or renal dysfuction
Treatment with antiplatelet agents

26
Q

What is the role of ORBIT?

A

Helps to assess bleeding risk on anticoagulants

27
Q

AF : Anticoagulation

A

Long term stroke prevention
First line : DOAC - Apixaban
2. Warfarin

28
Q

AF : Post stroke anticoagulation

A
  1. Post TIA : start anticoagulation immediately
  2. Post Stroke - commences after 2 weeks
29
Q

Investigation : Palpitations

A

First line
1. ECG
2. Bloods : TFT, U+Es, FBC

Second line - exclude episodic arrhythmia
1. Holter monitoring for 24 hours or more

Third line
1. External/Implantable loop recorder\

Cardiology (24 decks)

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