Atrial fibrillation Flashcards Preview

Internal Medicine > Atrial fibrillation > Flashcards

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

Warfarin dose

Start at 5mg