Atrial FIbrillation

Question 1

atrial contraction in AF

Answer 1

uncoordinated, rapid and irregular

Question 2

p waves on ECG

Answer 2

absent

Question 3

complications

Answer 3

tachycardia
heart failure
risk of embolic stroke

Question 4

presenting symptoms

Answer 4

often incidental

palpitations, SOB, syncope

Question 5

2 differentials for irregularly irregular pulse

Answer 5

AF

ventricular ectopics

Question 6

AF on an ECG

Answer 6

absent p waves
narrow QRS
irregularly irregular ventricular rhythm

Question 7

valvular AF

Answer 7

AF with mitral stenosis or mechanical heart valve

Question 8

most common causes of AF - SMITH

Answer 8

sepsis 
mitral valve pathology 
IHD
thyrotoxicosis 
hypertension

Question 9

2 principles for treatment

Answer 9

rate or rhythm control

anticoagulation

Question 10

rate control

Answer 10

beta blocker - atenolol 10-100mg
CCB
digoxin

Question 11

rhythm control

Answer 11

cardioversion

Question 12

immediate vs delayed cardioversion

Answer 12

immediate if present less than 48hrs or haemodynamically unstable

Question 13

delayed cardioversion and anticoagulation

Answer 13

3 weeks prior

mobilising clot and causing stroke

Question 14

pharmacological cardioversion

Answer 14

Flecanide

Amiodarone

Question 15

electrical cardioversion

Answer 15

sedation and cardiac defibrillator

Question 16

long term medical rhythm control

Answer 16

beta blockers

amiodarone - left heart failure

Question 17

pill in the pocket treatment

Answer 17

flecanide

Question 18

where is blood common to become stagnated?

Answer 18

atrial appendage

Question 19

chadsvasc

Answer 19

whether somone with AF should start on anticoagulation

Question 20

HAS-BLED

Answer 20

anticoagulation risk of bleeding

Question 21

what does warfarin do to prothrombin time?

Answer 21

prolong it

Question 22

What is the INR?

Answer 22

prothrombin time compared to normal adult

2 - twice as long to clot

Question 23

what enzyme affects warfarin?

Answer 23

liver enzyme cytochrome p450

Question 24

what can affect enzyme levels?

Answer 24

antibiotics

leafy green veg, cranberry juice and alcohol

Question 25

on warfarin and bleeding?

Answer 25

vitamin K injection

Question 26

advantages of DOACs over warfarin

Answer 26

no monitoring no major interactions equal preventing stroke equal or less chance of bleeding

Question 27

what does chads2vasc stand for?

Answer 27

``` congestive heart failure hypertension age >75 (2 points) diabetes stroke (2 points) vascular disease age 65-74 sex ```