Cardiology Flashcards
(25 cards)
What is paroxysmal AF?
Episodes stop within 48 hours without treatment
What is persistent AF?
Episodes last > 7 days
What are the two aims of treatment for arrythmias?
Rate control: controls ventricular rate
Rhythmn control: Restores and maintains sinus rhythmn
What is permanent AF?
AF is present all the time
What are the symptoms of AF?
Heart palpitations
Dizziness
SOB
Tiredness
What are the complications of AF?
Stroke and heart failure
How should patients who present with acute new-onset AF with life-threatening haemodynamic instability be treated?
Electrical cardioversion
- Give parenteral anticoagulant and rule out atrial thrombus immediately before procedure
How should patients who present with acute new-onset AF without life-threatening haemodynamic instability be treated?
<48 hours = rate or rhythm control (electrical or amiodarone/flecanide)
>48 hours = rate control (verapamil, beta blocker)
What can be given if urgent rate control is required?
IV beta blocker
Verapamil (if LVEF >40%)
When should calcium channel blockers be avoided in AF?
In patients with suspected concomitant acute decompensated HF
What can be given for pharmacological cardioversion?
Flecainide (if no structural or IHD)
Amiodarone
Why is cardioversion not recommended if symptoms are present >48 hours?
Increased risk of stroke
(Clots can pool in atria which can be released when shocked and go to the brain)
How long does a patient need to be anticoagulated for before cardioversion?
Fully anticoagulated for 3 weeks before and continue for 4 weeks after
What is the first line treatment strategy for maintenance of AF?
Rate control
Beta blockers - (not sotalol), rate limiting CCB, digoxin
When is rate control not the preferred first line treatment strategy for AF?
In patients with new onset AF
With atrial flutter suitable for ablation
AF with a reversible cause
Heart failure primarily caused by AF
When should digoxin monotherapy only be considered for initial rate control?
Those with non-paroxysmal AF who are predominantly sedentary
Those where other rate limiting drugs are unsuitable
What should be considered if monotherapy fails to adequately control ventricular rate?
Dual therapy: BB (not sotalol), rate-limiting CCB, digoxin
If this fails - rhythm control should be considered (beta blockers or oral anti-arrhytmic drugs)
If LVEF <40% what combination of drugs should be used to control ventricular rate?
Beta blocker
Digoxin
What drugs should be given if rhythm control is still required post cardioversion?
First line: Beta blockers (not sotalol)
Second line: Oral anti-arrhythmic drugs
e.g. sotalol, amiodarone, flecainide, propafenone, dronedarone
What does ‘Pill in Pocket’ mean?
For patients with paroxysmal/symptomatic AF
Infrequent episodes - able to self treat with flecainide or propafenone
What anti-arrhythmic drugs are contra-indicated in asthma / severe COPD?
Flecainide
Propafenone
What anti-arrhythmic drugs are contra-indicated in structural / IHD?
Flecainide
Propafenone
What is the treatment for atrial flutter?
Similar treatment as Afib but catheter ablation more suitable
What is included n the CHADSVASc tool?
C = chronic HF or LVD
H = HTN
A = 75+
D = T2DM
S = Stroke/TIA/VTE history
V= Vascular disease
A= 65-74 years
S= Sex category
