FN: Atrial Fibrillation Flashcards Preview

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Flashcards in FN: Atrial Fibrillation Deck (25):
1

Pathology

LA lose refractories before the end of atrial systole--> recurrent uncoordinated contraction
Atrial contraction responsible for 25% of CO therefore often triggers heart failure

2

Causes common

IHD
Rheumatic heart disease
Thyrotoxicosis
Hypertension

3

Other causes

Alcohol
Pneumonia
Pe
Post-op
Hypokalaemia
RA

4

Symptoms

asymptomatic
Chest pain
Palpitations
Dyspnoea
Faintness

5

Signs

Irregularly irregular pulse
Pulse deficit: difference between pulse and HS
--> Fast AF - loss of diastolic filling - no palpable pulse

Signs of LVF

6

Investigation

ECG
FBC, U+E, TFTs, Troponing
Consider TTE: structural abnormalities

7

Acute AF (

Haemodynamically unstable - emergency cardioversion (IV amiodarone 2nd line)

8

Acute AF Control ventricular rate

1st line: diltiazem or verapmil or metoprolol
2nd line: digoxin or amiodarone

9

Acute AF start

LMWH

10

Cardioversion use when

acute AF

11

Pharmacological cardioversion

1st: flecainide, propafenone
2nd: Amiodarone

12

Paroxysmal AF

1. Self-limiting

13

Persistent AF

>7d may recur even after carioversion

14

Attempt rhythm control as first-line in persistent AF if

1. Symptomatic or CCF
2. Younger (

15

Rhythm Control

1. TTE first: structural abnormalities
2. Anticoagulate with warfarin for >3wks
3. Pre-Rx >4 wks wth sotalol or amiodarone if increased risk of failure
4. Electrical or pharmacologcal cardioversion
5. >4 wks anticoagulation afterwards (target INR 2.5)

16

Maintenance antiarrhythmic

Not needed if sucessfully treated precipitant
1st: Beta-blovker (e.g. bisoprolol, metoprolol)
2nd: amiodarone

17

Other options

Radiofreqeuncy ablation of AV node
Maze procedure
Pacing

18

Rate control (target

1st line: beta-blocker or rate-limiting CCB (not both)
2nd line: add digoxin (dont use as monotherapy)
3rd line: consider amiodarone

19

Management of permanent AF

1. Failed cardioversion/unlikely to suceed --> AF >1yr, valve disease, poor LV function
2. Pt. doesnt want cardioversion
3. Rate control

20

Management of Atrial flutter

Manage as for AF
Anti-AF drug may not work but try:
1. amiodarone to restore sinus
Amiodarone or sotalol to maintain it

2. Cavotricuspid isthmus ablation (RA) is Rx of choice

21

CHADSVas score

Determines necessity of anticoagulation in AF

22

Warfarin contraindications

Bleeding diatheis
reduced platelets
BP >160/90
Poor compliance

23

CHADS VAS stands for

CCF
HTN
Age >75 (2 points)
DM
Stroke or TIA(2 points)
Vascular disease
Age: 65-75yrs
Sex: female

24

CHADSVAS score of 0

aspirin 300mg

25

CHADSVAS of >1

Warfarin

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