Atrial Fibrillation/Flutter Flashcards Preview

Year 3 Rapid Medicine Cardiology > Atrial Fibrillation/Flutter > Flashcards

Flashcards in Atrial Fibrillation/Flutter Deck (21)
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1

What is atrial fibrillation?

Arrythmia (irregular heartbeat) characterisied by rapid, chaotic, and ineffective atrial electrical conduction

2

What are the groups of causes of atrial fibrillation?

- No identifiable cause ('lone' AF)
- Systemic causes
- Cardiac causes
- Lung causes

3

What is the principle behind secondary causes of AF?

They lead to abnormal atrial electrical pathways resulting in AF

4

Systemic causes of AF?

- Thyrotoxicosis (hyperthyroidism)
- Hypertension
- Pneumonia
- Alcohol

5

Cardiac causes of AF?

Mitral valve disease
Ischaemic heart disease
Rheumatic heart disease
Cardiomyopathy
Pericarditis
Sick-sinus syndrome
Atrial myxoma (tumour)

6

Lung causes of AF?

Bronchial carcinoma
Pulmonary embolism

7

Who is AF most common in?

Elderly (~5% of 65+)
May be paroxysmal

8

Presentation of AF?

Often asymptomatic
Some patients experience palpitations or syncope
Symptoms are mostly those of the cause

9

Examination findings in AF?

Irregularly irregular pulse
Difference in apical beat and radial pulse
Potential exam findings of thyroid disease and valvular heart disease

10

Investigations indicated in AF?

ECG
Bloods
Echocardiogram

11

ECG findings in AF?

Uneven baseline (fibrillations) with absent P waves and irregular QRS complexes

12

Which blood tests are indicated in AF?

Cardiac enzymes
TFTs
Lipid profile
U&E
Mg2+
Ca2+
- last 2 could be digoxin toxicity - raised digoxin conc + hypokalaemia/hypomagesaemia/hypercalcaemia

13

Potential findings on echocardiogram in AF?

Mitral valve disease
Left atrial dilation
Left ventricular dysfunction
Structural abnormalities

14

Management stages of AF?

Treat reversible causes (e.g. thyrotoxicosis, chest infection)
- rhythm control
- rate control
- thromboembolism prophylaxis

15

Methods of rhythm control in AF?

Cardioversion - DC or chemical (flecainide or amiodarone)
- anticoagulate first if >48 hrs after onset
- don't use flecainide if Hx of ischaemic heart disease

16

Drugs for prophylaxis of AF?

Sotalol, amiodarone, or flecainide

17

Who is rate control attempted in and how in AF?

Chronic 'permanent' AF - ventricular rate control with digoxin, verapamil and/or beta blockers
- aim for rate of ~90/min

18

Management of thromboembolism risk in AF?

Low-risk = aspirin
High-risk = warfarin

19

Risk factors for high thromboembolism risk?

- Previous thromboembolic event
- Age 75+ and hypertension
- Diabetes
- Vascular disease
- Clinical evidence of valve disease
- Heart failure
- Impaired left ventricular function

20

Complications of AF?

- Thromboembolism
- Worsening of any existing heart failure

21

Prognosis of chronic AF?

Chronic AF in a diseased heart does not usually return to sinus rhythm