Atrial Fibrillation

Question 1

Define Atrial Fibrillation

Answer 1

is a common arrhythmia where the atria are activated and contract irregularly and rapidly in an uncoordinated way.

Question 2

AF ECG findings

Answer 2

• absent p waves
• irregular QRS complexes

Question 3

3 classifications

NICE AF classifications

Answer 3

1. Paroxysmal AF
2. Persistent AF
3. Permanent AF

Question 4

Define Paroxysmal AF

Answer 4

AF which terminates spontaneously within seven days of onset and most often within 48 hours of onset.

Question 5

Define persistent AF

Answer 5

AF present continuously for > 7 days or terminated by cardioversion.

Question 6

Define Permanent AF

Answer 6

AF > 7 days without attempted cardioversion or which cannot be terminated by cardioversion (unable to get back to SR)

Question 7

AF Sx

mostly asyptomatic

Answer 7

Palpitations
Chest pain or tightness
Shortness of breath
Reduced exercise tolerance
Light-headedness
Syncope
Fatigue

Question 8

AF clinical signs

Answer 8

• irregularly irregular pulse with variable volume
• Radial-apical deficit (some contractions are not adequate to produce a radial pulse)
• Haemodynamic instability (Tachy, hypo, LOC, pulmonary oedema)

Question 9

AF pathological changes

Answer 9

Atrial fibrosis - dilatation of the atria –> physical / electrical remodelling

Question 10

How AF contribute to thrombosis

Answer 10

1. Struc. and func. changes in the atrial myocardium + stasis of blood (Left atrial appendage) –> thrombus
2. Damage to myocardium expression of prothrombotic factors + PLTs + inflammatory cells –> thrombus

Question 11

AF cardiac causes

Answer 11

Ischaemic heart disease
Hypertension
Valvular heart disease (including rheumatic heart disease, typically affecting the mitral valve)
Heart failure
Cardiomyopathies
Myocarditis and pericarditis
Recent cardiothoracic surgery

Question 12

PIRATES mnemonic

AF non-cardiac causes

Answer 12

• Electrolyte disturbances (e.g. hypokalaemia, hypomagnesaemia)
• Acute infections e.g. pneumonia, sepsis
• Pulmonary embolism
• Hyperthyroidism
• Alcohol excess
• Smoking
• Medications (e.g. lithium)

Question 13

AF Mx for unatable pt

shock (SBP < 90), syncope, MI (CP), HF

Answer 13

1. Syn DC shock up to 3x
2. Amiodareon 300mg IV
3. another Syn DC shock
4. Amiodarone 900mg IV over 24h

Question 14

AF Mx for stable patient <48h onset

Answer 14

Rhythm control (Tx dose LMWH)
1. Syn DC shock
2. Flacanide or Amiodarone (IHD / LVD dysfunc.)

Question 15

AF Mx for stable patient > 48h onset

Answer 15

Rate Control
1. Bisoprolol or Verapamil (target HR < 110bpm)

Question 16

AF Mx over flow

Answer 16

1. Rate (> 48h) or Rhythm (< 48h) Control
2. Anticoagulant (CHA2DS2VASc)
   - Male >1
   - Female >2

Question 17

what complication can syn DC shock cause

Answer 17

can dislodge a thrombus that has already been formed.

Question 18

anticoagulant indication for ryhthm control > 48h

Answer 18

DOAC for 3/52 prior to syn DC shock and 4/52 after

Question 19

Paroxysmal AF Mx

Answer 19

1. Flecanide (no struc/func heart disease)