Rate, Rhythm And CHADVASC Flashcards
What is preferred 1st line for AF?
Rate control!!!
What are the exceptions to rate control?
- when rhythm is proffered
- new onset of AF
- Atrial flutter - where we old need to use ablation strategy(using hot cor cold energy to block signal and restore)
- AF that has a reversible cause - MI,hyperthyroidism, caffeine, excess alcohol
- Heart failure that is caused by AF
Or just if rhythm is more suitable
What is rate control drug treatment?
- monotherapy, starting off with one drug at a time and gradually seeing the impact of adding one and removing one.
- DIVED BETA (Diltiazem, Digoxin ,verapamil and beta blocker)
- digoxin specifically is its non paroxysmal AF
If monotherapy is inadequate what do we do?
We can try combinations = BB, DD = Betablockers , diltiazem and digoxin but no verapamil
What happens if rate still isn’t controlled?
Switch to rhythm
Rhythm control needs what first
Electrical or pharmacological cardioversion
What needs to be done before the cardioversion?
Specifically if the AF has gone on for 48 hrs + then electrical is proffered over pharma, but we need to delay it until the patient has been fully anticoagulated for at least 3 weeks as there is a risk of stroke with electrical cardioversion
(Because a clot can move to different parts of the body)
What happens if we can’t give them anticoagulation?
Give then a heparin immediately before cardioversion, oral anticoagulation should be given after cardioversion and continued for at least 4 weeks
What are the steps for Rhythm control drug treatment?
FAB rhythms - Flecanide, amiodarone and betablockers.
Sotalol can be given but just not as first line
- others are profenone(avoided in heart disease), Dronedarone
When we say pharmacological cardioversion, what drugs are used?
Flecanide or amiodarone (if structural or ischaemic heart disease)
How to assess the risk of stroke and bleeding for patients that have AF?
1) For stroke - Chadvasc
2) For a bleed - Orbit score or hasbled(which is older but could still be asked)
What’s the equation for giving an anticoagulant
When the risk of stroke is greater than the risk of bleeding
CHADsVASC score of what warrants no anticoagulation?
Females = 1
Males = 0
Remember a score of what needs anticoagulation
For men =1
For women = 2
Or greater then you must add an anticoagulant
Chadvasc parameters
Congestive heart failure
Hypertension
Age greater than 75
Age 65-74
Diabetes
Stroke
Vascular disease
Sex
Age over 75
Stroke and TIA
What is previous vascular disease classified as?
Previous MI,Perpheral arterial disease or aortic plaque
Orbit score is what?
The Risk of bleeding
What are the orbit score parameters?
Older than 74= o
Reduced haemoglobin history(anaemia) = 2
Bleeding history = 2
Inadequate renal function, eGFR greater than 60 = 1
Treatment with anti platelets =. 1
Max score = 7
What do the scores mean?
0-2 =low risk of bleeding
3= medium risk of bleeding ( monitor and give)
4-7=high risk of bleeding (don’t give, risk too high)
Hasbled - very outdated but memorise just in case
Hypertension - 1
Abnormal renal/ liver = 1 or 2
Stroke = 1
Bleeding tendencies = 1
Labile INR = 1
Age greater than 65 = 1
Drugs(aspirin,NSAIDs or alcohol)
Max score = 9
