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Atrial Fibrillation Flashcards

(48 cards)

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1
Q

What is atrial fibrillation?

A

Condition where the electrical activity in the atria become disorganised > fibrillation + irregularly irregular pulse

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2
Q

What is fibrillation?

A

Random muscle twitching

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3
Q

Overall effects of AF

A
  • tachycardia
  • irregular irregular pulse
  • heart failure pEF
  • increased stroke risk
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4
Q

AF on an ECG

A
  • irregularly irregular
  • narrow QRS tachycardia
  • absent P waves
  • irregular gaps between QRS complexes
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5
Q

Why does AF increase risk of stroke?

A
  • uncoordinated atria activity leads to stasis of blood > blood stagnates in atria
  • thrombus formation
  • this can travel to the brain + block a cerebral artery > ischaemic stroke
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6
Q

Common causes of AF

A

SMITH
- Sepsis
- Mitral stenosis or regurgitation
- IHD
- Thyrotoxicosis (hyper)
- Hypertension
- high alcohol + caffeine intake

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7
Q

Presentation of AF

A
  • often asymptomatic
  • irregularly irregular pulse
  • palpitations
  • SOB
  • dizziness or syncope
  • symptoms of assocaited symptoms e.g. hyperthyroidism
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8
Q

What arrhythmias can cause irregularly irregular pulse?

A

AF
Ventricular ectopics

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9
Q

Investigations of AF

A
  • manual pulse
  • ECG
  • echocardiogram
  • 24 hour cardiac monitoring in paroxysmal AF
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10
Q

What is paroxysmal AF?

A

Episodes of AF that occur intermittently

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11
Q

Investigations of paroxysmal AF

A

24 ambulatory ECG (first line)
Cardiac event recorder over 1-2 weeks

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12
Q

What is valvular AF?

A

AF with significant mitral stenosis or mechanical heart valve

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13
Q

When should an echo be done?

A
  • if suspected structual heart disease e.g HF or valvular heart disease
  • where a rhythm control strategy e.g. cardio version is being considered
  • baseline echo to inform long term Tx
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14
Q

Principles of AF management

A
  • anticoagulation to prevent stroke
  • rate (first line) or rhythm control
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15
Q

Most common combination of treatment for AF

A

beta blocker for rate control
DOAC for anticoagulation

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16
Q

Aim of rate control in AF

A
  • Heart rate <100 bpm
  • Extend the time during diastole for ventricles to fill
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17
Q

Options for rate control in AF

A
  • Beta blocker e.g. bisoprolol - first line
  • CCB e.g, verapamil or Diltiazem
  • digoxin - in sedentary people + risk of toxicity
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18
Q

Is rate or rhythm control first line in AF?

A

Rate control is first line

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19
Q

Normally rate control is first line in AF, when is it not?
Therefore, rhythm control is offered

A
  • reversible cause of AF
  • new onset of AF (within 48 hours)
  • heart failure caused by AF
  • symptoms despite being effectively rate controlled
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20
Q

Aim of rhythm control in AF

Study These Flashcards
A

Return patient to normal sinus rhythm

21
Q

Options of rhythm control in AF

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A
  • cardioversion: immediate or delayed
  • long term managment with meds
22
Q

When is immedaite cardioversion used for rhythm control in AF?

Study These Flashcards
A
  • AF present for <48 hours
  • causing life threatening Haemodynamic instability
23
Q

Options for immediate cardioversion

Study These Flashcards
A
  • Pharmacological: flecainide or amiodarone
  • electrical: using cardiac defibrillator
24
Q

What drugs are used for pharmacological cardioversion?

Study These Flashcards
A

flecanide
amiodarone (if structural heart disease)

25
When is delayed cardioversion used for rhythm control in AF?
AF present for >48 hours + pt stable
26
Options for delayed cardioversion in rhythm control of AF
- **transoesophageal echocardiogram guided cardioversion** - first line - ***amiodarone*** after
27
Drug options for long term rhythm control in AF
- **beta blockers**: first line - ***dronedarone***: second line to maintain normal rhythm - ***amiodarone***: pts with HF or LV dysfunction
28
Management of paroxysmal AF
- ‘pill in pocket’ approach - take ***flecainide*** when they feel symptoms - CHADSVASC score + anticoagulation if needed
29
What can be used if drug treatment of rate + rhythm control of AF is not tolerated?
**Ablation**: - left atria ablation - AV node ablation + pacemaker
30
Outline anticoagulation in AF
- **CHA2D2SVASC** score to predict risk of stroke - **DOAC** first line investigations - **warfain** second line
31
What is the CHA2DS2VASC score?
- tool to assess whether a patient withi AF should start anticoagulation based of risk of stroke - **C**ongestive cardiac failure - **H**ypertension - **A2**ge >75 (scores 2) - **D**iabetes - **S2**troke or TIA before (scores 2) - **V**ascular disease - **A**ge 65-74 - **S**ex female .
32
Results of CHA2DS2VASC score
- 0 - no anticoagulation needed - 1 - consider - 2+ - offer anticoagulation
33
Mechanism of action of DOACs + examples
- **direct factor Xa inhibitors**: *apixaban, edoxaban, rivaoxaban* - **direct thrombin inhibitor**: *dabigatran*
34
Reversal agents of DOACs
- ***andexanet alfa*** - *apixaban + rivaroxaban* - ***idarucizumab*** - *dabigatran*
35
Mechanims of action of warfarin
Vitamin K antagonists Prevents function of clotting factors II, VII, IX + X Prolonged PT time
36
What clotting factors does warfarin inhibit?
II VII IX X
37
Outline INR
- international normalised ratio - calculates patietns PT time compared to average healthy adult - INR 1 - normal PT time compared - INR 2 - PT twice as long as normal healthy adult
38
Target INR for AF
2-3
39
Reversal agent of warfarin
Vitamin K
40
What scores can be used to assess risk of major bleeding in pts with AF taking anticoagulation?
ORBIT HAS-BLED
41
Outline ORBIT score
- assesses risk of major bleeding in AF pts on anticoagulation - **O**lder age >75 - **R**enal impairment eGFR <60 - **B**leeding previously - **I**ron (low Hb or haematocrit) - **T**aking antiplatelet meds
42
Outline HAS-BLED score
assesses risk of major bleeding
43
What is left atrial appendage occulsion?
- Option for patients with contraindications to anticoagulation + high stroke risk - left atrial appendage is most common site for thrombus to form - plug placed in LAA to prevent blood from entering > reducing thrombus risk
44
What class of drug is amiodarone?
Group III anti-arrhythmic Blocks K+ channels
45
Mechanism of action of amiodarone
- blocks K+ channel - prolongs repolarisation by inhibiting K+ efflux - prolongs AP
46
Side effects of amiodarone
- lung fibrosis - hepatotoxic - optic neuritis - thyroid toxicity - peripheral neuropathy
47
Contraindications of amiodarone
Heart block Active thyroid disease
48
How can you differentiate between an irregularly irregular pulse due to AF and ventricular ectopics?
- Ventricular ectopics disappear when Hr increases above a certain threshold - Increased regular HR during exercise suggests ventricular ectopics

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