CPRS Case 1: Atrial fibrillation Flashcards Preview

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Flashcards in CPRS Case 1: Atrial fibrillation Deck (11)
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1

Understand anatomy and physiology of normal cardiac conduction system

See lecture

2

Understand basic principles of 12-lead ECG recording

See lecture + physiology practical

3

Describe mechanisms of action, side effects, CI of rate-controlling agents

See lecture Antiarrhythmic drugs

Rate-controlling:
Class II: Beta blocker
Class IV: Calcium channel blocker
Cardiac glycoside: Digoxin

4

Mechanism of action, SE and CI of oral anticoagulants

Warfarin:
- inhibit Vitamin K epoxide reductase + Vitamin K quinone reductase
- Vitamin K epoxide —not reduced—> Vitamin K hydroquinone
- No Vitamin K hydroquinone to be oxidised —> no activation of clotting factors
- Narrow therapeutic index
- Bleeding
- Hepatcially eliminated —> interaction with other drugs

NOACs:
- direct thrombin inhibitor / factor Xa inhibitor
- rapid onset
- short half-lives
- routine monitoring less important
- Renally eliminated

5

Diagnostic approach to palpitations

1. Manual pulse palpation to assess presence of irregular pulse in
- breathlessness
- palpitations
- transient ischaemic attack
2. ECG in all people if irregular pulse detected
3. Transthoracic echocardiography
4. Transoesophgeal echocardiography

6

Risk factors, presentation and complications of atrial fibrillation

Risks factors:
- >60
- DM
- Hypertension
- Congestive heart failure
- Structural heart disease
- Coronary artery disease
- Prior heart attacks

Presentation:
- Palpitations
- Breathlessness
- Transient ischaemic attack
- Syncope
- Chest pains
- Fatigue

Complications:
- Stroke
- Heart failure

7

Principles of management of atrial fibrillation

Acute presentation:
- life-threatening —> emergency electrical cardioversion
- non-life threatening —> pharmacological cardioversion (amiodarone)

Drug treatment:
1. Rate control drugs:
—> symptoms not controlled by 2 rate-control drugs —> rhythm control
2. Anticoagulation drugs (Stroke prevention):
—> CHAD2S2-VASc assessment tool for stroke risk
—> HAS-BLED tool for bleeding risk

8

Promote cessation of health-risk behaviours in primary care setting

- Smoking cessation (see lecture)
- reduce alcohol intake

9

Disease burden of atrial fibrillation for patient and society

1. Most common heart rhythm disorder in the world
- increase risk of morbidity and mortality
- risk of stroke
- risk of heart failure

2. Life-long chronic disease

3. Quality of life is significantly poorer
- disability
- high number of drugs
- anxiety
- disease progression

4. Caring for family members with AF

5. Limitations after stroke
- cognitive impairment
- problem with communication
- paralysis

6. Financial burden on healthcare system
- cost of treatment and prevention is high

10

Principles of screening for health condition

- Presumptive identification of unrecognised disease in apparently healthy asymptomatic population by means of tests that can be applied easily to target population

1. systematic invitation + follow-up
2. participation > 70% of target population
3. necessary infrastructure and resource to offer the test and adequately diagnose
4. robust monitoring and valuation framework to assure quality

- undertaken only when effectiveness is demonstrated
- resources are sufficient to cover all target group
- treatment and follow up ensured with abnormal results
- prevalence is high enough to justify cost and effort of screening

For atrial fibrillation, opportunistic screening > targeted screening

11

4 basic principles of medical ethics in patient management

1. Respect for autonomy
2. Non-maleficence
3. Beneficence
4. Justice