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Week 5 - Phase 3 > Atrial Fibrillation > Flashcards

Atrial Fibrillation Flashcards

1
Q

What is the most common sustained cardiac arrhythmia?

A

AF

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2
Q

List symptoms of AF?

A
  • asymptomatic
  • palpitations
  • chest pain
  • syncope (due to rapid/slow HR)
  • SOB
  • may present with stroke/embolism
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3
Q

Why do patients get SOB in AF?

A

If in AF, you lose atrial kick to help fill ventricles so you get a decreased cardiac output.

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4
Q

Describe the pulse in AF?

A

Irregularly irregular.

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5
Q

List and describe the 3 types of AF?

A

Paroxysmal: Intermittent - episodes start and stop. They can last seconds - 24h.

Persistant: Wont stop alone, requires intervention to stop.

Permanent: Intervention wont stop it.

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6
Q

Describe the AF ECG?

A
  • variable rate
  • irregular narrow QRS
  • no P waves
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7
Q

Describe atrial contraction in AF?

A

Atria don’t contract together. Different cells contract at different rates.
Atria ‘wobble’ rather than contracting.

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8
Q

How does atrial fluter differ from AF physiologically?

A

Atria contract in a coordinated way but very fast.

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9
Q

Why do the atria contract faster than the ventricles in atrial flutter?

A

Because the atria are contract so fast that not impulses get through due to variable degrees of AV block.

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10
Q

Describe atrial flutter on ECG?

A
  • Variable rate
  • Regular, narrow QRS
  • ‘Sawtooth’ atrial activity at around 300bpm.
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11
Q

Who is more likely to get AF?

A

Older people

Males

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12
Q

List some conditions predisposing to AF?

A 
Hypertension
HF
Valvular HD 
Thyroid dysfunction (particularly hyperthyroid)
Cardiomyopathies
Diabetes
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13
Q

List GGC’s objectives of AF treatment?

A
  • prevention of stroke
  • symptom relief
  • management of CV disease
  • rate contol
  • +/- correction of rhythm disturbance.
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14
Q

How would you investigate suspected AF?

A
  • ECG to confirm arrhythmia.
  • Echocardigram
  • Thyroid function tests
  • Liver function tests
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15
Q

What is the target HR in AF patients?

A

<100bpm

if still symptomatic at 100 then aim for 80 bpm.

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16
Q

What drugs are used to ‘rate control’ in AF?

A

Either a B-blocker (bisoprolol)

OR rate-limiting Calcium channel antagonist (verapamil).

17
Q

List MAJOR risk factors for stroke and thrombo-embolism.

How many points are these worth?

A
  • previous stroke
  • TIA or systemic embolism
  • age >75 years.

2 points

18
Q

List Clinically-relevant NON-MAJOR risk factors for stroke or thrombo-embolism?
How many points are these worth?

A
  • Chronic heart failure or severe LV dysfunction.
  • Hypertension
  • Diabetes
  • Aged 65-74
  • Female
  • Vascular disease.

1 point.

19
Q

Stroke risk is calculated by assigning points for major and clinically relevant non-major risk factors. What is this score out of? aka Max score.

A

9

20
Q

How do we reduce stroke in patients at high risk?

A

Used to give warfarin (but needed INR monitoring).
Now use new oral anti-coagulation
- Dabigatran (thrombin inhibitor)
- Rivaroxiban/Apixaban/Edoxaban (Factor Xa inhibitor)

21
Q

What patients with AF would get reffered for specialist treatment?

A
  • Symptomatic patients despite rate control.
  • Patients <60 yo.
  • Inadequate rate control despite B-blocker/Ca antagonist + digoxin.
  • Structural heart disease seen on echo e.g. valve disease or LV dysfunction.
  • AF and co-existing HF.
22
Q

When is ‘rhythm control’ used in AF?

A

In younger patients and those with ongoing symptoms despite rate control.

23
Q

What options are available for rhythm control?

A

Direct current cardioversion
Anti-arrhythmic drugs
Catheter ablation

24
Q

What anti-arrhythmic drug options?

A

Class 1: Na+ channel blockers.

  • Flecainide
  • Propafenone

Class 3: K+ channel blockers (prolong AP duration and QT interval)
- Sotalol

Multi-channel Blockers
- Dronedarone

25
Q

Where else other than the atria can abnormal beats come from?

A

Sometimes abnormal beats come from the pulmonary vein.

Due to sleeves of myocardium going from LA to the pulmonary vein.

26
Q

Describe the process of catheter ablation?

A

Radiofrequency ‘point-to-point’ ablation.

Cryo-balloon ablation. administering liquid nitrogen around the pulmonary veins.

Week 5 - Phase 3 (7 decks)

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