Flashcards in Atrial fibrillation Deck (29)
1
Classification
Paroxysmal-->come on suddenly, revert spontaneously
Persistent-->abrupt onset, lasting days/weeks unless active measures to revert
Chronic-->inability to sustain sinu rhythm
2
Overview treatment
Rate control
Rhythm control
Anticoagulation
3
Initiation
Single circuit re-entry, ectopic acts as aberrant generators producing atrial tachyC
4
Maintenance, why is AFib more like to cause further AFib
The tachycardia causes atrial structural and electrophyisiological remodelling changes, further promoting AFib.
The longer they are in AFib the more difficult to revert
5
CHADS2 Risk of
Congestive heart failure
Hypertension
Age >75 (2) 65-74 (1)
Diabetes
Stroke/TIA (2)
Female sex
Vascular disease
6
CHADS score and stroke risk
0-->1.9% low risk Aspirin
1-->2.8% mod risk Oral anticoagulants
2-3-->4-6% mod risk Oral anticoagulant
4-6-->8-18% high risk Oral anticoagulant
7
ECG findings
No organised P waves
Rapid atrial activity
Fibrillatory baseline
Irregularly irregular
Wide QRS due to aberrancy
8
CVS examination findings
Palpitations
Dizziness
Dyspnea
Irregularly irregular pulse
Absent a wave on JVP
No S4 on auscultation
9
To obtain and maintain long term ventricular rate
Atenolol or metoprolol
10
When can digoxin be used
Elderly sedentary patient
AFib + heart failure
11
Causes
CAD
HTN
HF
Valvular disease
Pericardial/Pleural disease
Diabetes
Thyroid
Alcohol
Fever
PE
12
Investigations
ECG
UEC-->potassium, magnesium
Troponins
TSH, T3, T4
CXR-->cardiomegaly, pneumonia (precipitant)
TOE-->thrombus
TTE-->CCF, valvular disease
13
Management in acute AF->when
02, IV access
ECG trace
Cardioversion-->electrical (100j in normal, 200J in larger) or chemical with amiodarone or flecainide (no CAF, normal LVF)
Atenolol
Enoxaparin for few days
14
When should cardioversion immediately be performed
Severe symptoms or compromised hemodynamically
15
When is it generally safe to cardiovert either electrically or chemically
Certain episode has been
16
What is the concern with using flecainide
May accelerate ventricular rate
17
Consider using which agents prior to cardioverting with flecainide
AV node blocker-->digoxin, beta blocker, verapamil
18
Management when unsure of time or >48 hours
02, ECG monitoring
TOE
If no thrombus->cardiovert
If thrombus, or TOE not done, fully anticoagulate for 3 weeks with enoxaparin 1mg/kg SC BD
Oral anticoagulation if required->warfarin
19
Atrial stunning
Unpredictable failure of atria to contract
20
When starting warfarin, what is the regime with heparin
Heparin concurrently for 5 days + until INR >2 on 2 consecutive days
21
Is long term therapy antiarrythmic required if AF due to transient condition
No
22
Maintenance of sinus after cardioversion
Flecainide or sotolol
23
What needs to be monitored with sotolol therapy
Excessive QT prolongation
24
Risk reduction of stroke with warfarin
70%
25
Risk of bleeding per annum
1-1.5%, up to 13% in 80yo +
26
Is the CHA2DS2Vasc for non-valvular or valvular
Non-valvular heart disease
27
What CHADSVasc score is indication for long term
>2
28
Aspirin dose if indicated
100-300mg daily
29