atrial fibrillation

Question 1

atrial fibrillation (AF)

Answer 1

supraventricular tachyarrhythmia resulting from irregular and disorganised electrical activity and ineffective atrial contraction

Question 2

first-diagnosed AF

Answer 2

not been diagnosed before regardless of symptom status, temporal pattern or duration

Question 3

paroxysmal AF

Answer 3

terminates spontaneously within a week or with intervention and atrial remodelling has not yet occurred

Question 4

persistent or continuous AF

Answer 4

episodes that are not self-terminating and lasts at least a year with treatment being an option for selected patients

Question 5

permanent AF

Answer 5

atrial remodelling has occurred and lasts more than a year with treatment not being an option

Question 6

AF pathophysiology (5)

Answer 6

electrical signals cross atria at the same time, atria quiver causing blood to pool and form a clot, some signals reach ventricles which contract irregularly, emptying of blood is impaired

Question 7

AF complications (3)

Answer 7

thromboemboli, acute heart failure, tachycardia

Question 8

thromboemboli complications (3)

Answer 8

stroke via carotid artery, ischaemic colitis via mesenteric arteries, acute limb ischaemia via femoral artery

Question 9

acute heart failure complications (2)

Answer 9

pulmonary oedema via atrial regurgitation into pulmonary veins or shock via decreased cardiac output

Question 10

tachycardia complication

Answer 10

dilated cardiomyopathy

Question 11

stroke risk in AF patients

Answer 11

5-6 times greater than people with normal sinus rhythm

Question 12

stroke risk after anticoagulant therapy

Answer 12

reduced by 2/3 (can prevent 6/10 strokes)

Question 13

AF causes

Answer 13

PIRATES - pulmonary diseases, ischaemia, remodelling of atria, alcohol, thyrotoxicosis, electrolyte imbalance, sepsis

Question 14

AF cardiac causes

Answer 14

CAD/MI, CHF, mitral stenosis (valvular AF)

Question 15

how does CAD/MI cause AF? (4)

Answer 15

cardiac ischaemia, cardiac fibrosis, atrial remodelling, re-entrant circuits

Question 16

how does CHF cause AF?

Answer 16

increased left atrial pressure

Question 17

how does mitral stenosis cause AF? (4)

Answer 17

blocked blood flow to ventricles, increased left atrial pressure, atrial remodelling, re-entrant circuits

Question 18

AF non-cardiac causes (6)

Answer 18

alcohol, electrolyte imbalances, pulmonary diseases, sepsis, thyrotoxicosis

Question 19

how do electrolyte imbalances cause AF?

Answer 19

ectopic firing of atrial cells

Question 20

how do pulmonary diseases cause AF? (2)

Answer 20

hypoxia, ectopic firing of atrial cells

Question 21

how does alcohol, sepsis and thyrotoxicosis cause AF? (3)

Answer 21

increased catecholamine release, beta1-adrenoceptor activation, ectopic firing of atrial cells

Question 22

AF symptoms (7)

Answer 22

asymptomatic, chest discomfort, dyspnea, fatigue, palpitations, stroke, syncope

Question 23

AF investigations

Answer 23

ECG, echocardiogram, bloods for electrolytes and TFTs

Question 24

AF ECG

Answer 24

variable R to R interval and rapid ventricular rate

Question 25

AF echocardiogram

Answer 25

left atrial dilation and/or thrombus formation

Question 26

AF blood tests

Answer 26

hypokalemia, hypomagnesemia, hyperthyroidism

Question 27

CHADS-VASc purpose

Answer 27

assesses stroke risk

Question 28

CHADS-VASc score >2

Answer 28

high risk of stroke, offer anticoagulants

Question 29

CHADS-VASc score = 1

Answer 29

consider anticoagulants

Question 30

CHADS-VASc score = 0

Answer 30

avoid anticoagulants and use aspirin

Question 31

ORBIT scoring

Answer 31

assesses bleeding risk

Question 32

AF management (3)

Answer 32

rate control, rhythm control (for acute AF), anticoagulation

Question 33

acute AF with unstable HD management

Answer 33

emergency DCC

Question 34

acute AF with stable HD < 48 hours onset (3)

Answer 34

anticoagulation, rate control or DCC

Question 35

acute AF with stable HD > 48 hours onset (2)

Answer 35

anticoagulation, rate control

Question 36

rate control drugs

Answer 36

amiodarone, beta blockers (for HF), rate-limiting calcium channel blockers (for asthma or diabetes), digoxin (for persistent or permanent AF)

Question 37

rhythm control

Answer 37

direct current cardioversion (within 4 weeks) and/or anti-arrhythmics

Question 38

anticoagulation drugs

Answer 38

DOACs (for non-valvular AF), vitamin K antagonists/warfarin (for valvular or non-valvular AF with CKD), heparin

Question 39

supraventricular tachycardia (SVT) treatment

Answer 39

IV adenosine with myocardial nuclear imaging

Question 40

bradyarrhythmia treatment

Answer 40

atropine

Question 41

ventricular tachycardia treatments (2)

Answer 41

IV magnesium sulphate, beta blocker, atrial pacing (avoid anti-arrhythmics)