Atrial Fibrillation Flashcards
how would the AF rhythm be described?
- irregularly irregular
- narrow QRS complexes
- absent p waves
describe common causes of AF?
- idiopathic (12%)
- hypertension
- coronary heart disease
- valvular heart disease
- cardiomyopathy
- Respiratory disease (lung cancer, COPD, PE, pulmonary hypertension)
causes of acute AF?
- alcohol
- infection
- surgery
- pericarditis
- MI/ PE
- hyperthyroidism
what are the symptoms?
- palpitations
- syncope
- breathlessness
- fatigue
- light headedness
- stroke/ TIA
investigations?
- ECG
- CXR
Bloods: - TFT’s
- FBC
- U&E (kidney function/ potassium)
when should an echo be done?
if the patient is <50 years old
How is paroxysmal AF managed?
- Beta- blocker PRN (e.g.atenolol 50-100mg)
- ” Pill in the pocket” (flecainide)
- remove known precipitants ( caffeine /alcohol)
when would you not prescribe the pill in the pocket in paroxysmal AF?
- systolic BP >100
- resting HR of >70
- LV dysfunction
- valvular or ischaemic Heart disease
- frequent paroxysms
- pill in the pocket only useful if infrequent and no underlying causes as above
what is the definition of paroxysmal AF?
Persistent?
Permanent?
- spontaneous termination within 7 days (most often within 48 hours)
- non self-terminating, lasting longer than 7 days (even if terminated, still in persistent AF)
- long standing (over a year)
explain the physiology behind pulmonary vein triggers?
- pulmonary veins have excess muscle with same SA node embryological tissue therefore can synapse and cause arrythmias.
How do you broadly manage AF?
- rate control
- rhythm control
- stroke/ bleeding risk
- treat the causes
How would you rate control?
Rate control:
- beta-blocker (cardiospecific, NOT sotalol)
- rate limiting calcium channel blocker (diltiazem or verapamil)
- Digoxin (only in non-paroxysmal AF, only good for sedentary patients)
how is stroke/ bleeding assessed?
- CHADS- VaSc score
(in paroxysmal/ permanent/ persistent AF) - HAS-BLED to assess bleeding risk in those being offered anti-coagulation
who should be offered anti-coagulation? and what with?
- those with CHADs-VASc score of 2 or above
- (rivaroxaban/ apixaban)
warfarin
when should you not offer rate control?
- AF with reversible cause
- heart failure caused by AF
- new onset
- atrial flutter with ablation
how do you rhythm control?
- cardioversion
- beta- blocker
- dronedarone (2nd line)
when should flecainide not be given?
- people with known structural or ischaemic heart disease
what is the benefit of catheter ablation?
- electrical isolation of the pulmonary veins
- prevent triggers and drives
what pulse would you like the hr at?
<110 bpm
