Atrial fibrillation/arrythmia

Question 1

Paroxysmal AF

Answer 1

Terminates spontaneously/with treatment within 7 days of onset

Question 2

Persistent AF

Answer 2

Continuous and sustained for more than 7 days

Question 3

Long-standing persistent AF

Answer 3

Continuous and sustained for more than 12 months

Question 4

Permanent AF

Answer 4

Joint decision by patient and clinician to cease attempts to restore sinus rhythm

Question 5

Lone AF

Answer 5

AF with no identifiable cause (around 10% patients)

Question 6

Commonest causes of AF (4)

Answer 6

Coronary heart disease
Hypertension
Valvular heart disease
Hyperthyroidism

Question 7

Rate control is first-line except: (4)

Answer 7

Reversible cause
Heart failure
New onset AF
For whom rhythm control is judged more suitable

Question 8

First-line treatment options for rate control in AF (3)

Answer 8

Beta-blocker
Rate-limiting calcium channel blocker
Digoxin

Question 9

When would digoxin be indicated for rate control?

Answer 9

Sedentary patients where other drug options are ruled out due to co-morbidity or patient preferences

Where co-exists with heart failure

Question 10

If monotherapy does not control symptoms, what is second-line?

Answer 10

Combination of two of beta-blocker, diltiazem, digoxin

seek specialist advice prior to co-prescription of diltiazem + beta blocker

Question 11

Drug methods of rhythm control? (3)

Answer 11

Amiodarone
Flecainide
“Pill in the pocket” for pAF

Question 12

Investigation prior to commencing flecainide or dronedarone?

Answer 12

Echo- these drugs contraindicated in structural cardiac disease

Question 13

Amiodarone toxicity? (4)

Answer 13

Pulmonary toxicity
Hypothyroidism
Hepatotoxicity
Corneal deposits

Question 14

CHA2DS2VaSc criteria?

Answer 14

C- CCF (1)
H- hypertension (1)
A2- age 65-74 (1)
     age >74 (2)
D- diabetes (1)
S2- stroke/TIA (2)
Vascular disease history (1)
Sex female (1)

Question 15

When should anticoagulation be considered?

Answer 15

All with CHADSVASC = 2 and men with CHADSVASC = 1

Question 16

HASBLED criteria?

Answer 16

(uncontrolled) Hypertension
(haemorrhagic) Stroke
Bleeding tendency
Labile INR
Elderly >65
Drugs e.g. aspirin, ibuprofen

Question 17

First-line anticoagulants in AF

Answer 17

NOAC e.g. apixaban, rivaroxaban

Question 18

eGFR limit for apixaban/rivaroxaban?

Answer 18

> 30

Question 19

Time in therapeutic range (TTR) aim for warfarin?

Answer 19

> 65%

Question 20

Non-drug means of rhythm control? (2)

Answer 20

DC cardioversion (acute if unstable or planned)
Left atrial catheter ablation

Question 21

When is pharmacological cardioversion preferred to electrical?

Answer 21

In the acute phase <48 hours, DC preferred if prolonged AF

Question 22

How long should a patient be anticoagulated for prior to DC cardioversion?

Answer 22

3 weeks

Question 23

Options for rhythm control in atrial flutter? (3)

Answer 23

Radiofrequency catheter ablation (preferred)
Pacing
Pharmacological cardioversion

Question 24

Management of recurrent episodes of SVT? (3)

Answer 24

Catheter ablation
Rate-limiting Ca blockers
Beta blockers

Question 25

Role of rate control in atrial flutter?

Answer 25

Control of rate pending eventual rhythm control strategy

Question 26

Pathological causes of bradycardia

Answer 26

Inferior MI Sick sinus syndrome Hypothyroidism Raised ICP

Question 27

1st degree heart block

Answer 27

PR > 200 msecs

Question 28

2nd degree block Mobitz I

Answer 28

progressive lengthening of PR interval with eventual dropped beat

Question 29

2nd degree block Mobitz II

Answer 29

constant prolonged PR interval with regular dropped beats (e.g. 2:1 pattern)

Question 30

3rd degree block

Answer 30

constant P-P intervals and R-R intervals but no relationship between P waves and QRS complexesd

Question 31

Management of heart block?

Answer 31

1st degree- monitor | 2nd/3rd degree- refer to cardiology, urgent emergency admission if symptomatic bradycardia

Question 32

Condition causing ventricular arrythmias +/- syncope/sudden death, often occuring at night, particularly affecting SE Asian populations

Answer 32

Brugada syndrome

Question 33

Inheritance of Brugada syndrome

Answer 33

Autosomal dominant, only 50% patients have a family history

Question 34

Congential accessory conduction pathway, ECG demonstrates delta wave

Answer 34

Wolff-Parkinson-White syndrome

Question 35

Change from lying - standing causing exaggerated orthostatic response in pulse > 30bpm

Answer 35

Postural tachycardia syndrome

Question 36

Diagnostic test for POTS?

Answer 36

Tilt-table testing