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PH2113 The Heart > Simon: Atrial Fibrillation: > Flashcards

Simon: Atrial Fibrillation: Flashcards

1
Q

What is the usual HR?

A

between 60-100 bpm at rest

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2
Q

What would be classed as too fast or too slow?

A

Above 100 bpm or below 60bpm at rest.

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3
Q

What is an arrhythmia?

A

Abnormal rate and or rhythm of the heartbeat, normally caused by disturbances in the normal electrical activity of the heart, having a big effect on contraction.

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4
Q

What are the 5 common arrhythmias?

A 
Ectopic beats
Atrial Fibrillation
Atrial Flutter
Ventricular Tachycardia
Ventricular Fibrillation
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5
Q

What are Ectopic beats?

A

These are heart beats that arise from anywhere in the heart excluding the SA node. These are common and usually harmless.

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6
Q

Why do Ectopic beats happen?

A

This is when another area of the heart exept the pace maker creates action potentials that are faster than those created in the SA node, therefore taking over

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7
Q

What is the result of Ectopic beats?

A

extra heart beats, tachycardia

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8
Q

What is the more serious arrhythmia when the action potentials no longer arise from the SA node at all?

A

An ectopic pacemaker, where an area of the heart takes over from the SA node completely, causing us to lose control of the action potentials, resulting in tachycardia.

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9
Q

What can cause an ectopic Pacemaker to happen?

A

Problems with the funny current can cause this - Funny currents cause action potentials but these are noemally interupted by the action potentials from the SA node. Problems with funny current - faster action potentials, result in the action potentials from the SA node not being able to interupt.

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10
Q

What is Atrial Fibrillation?

A

This is the most common sustained abnormal heart rhythm seen affectin around 1million in the UK. It is when there are increased action potentials firing to the Atrium.

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11
Q

How would an ECG of atrial fibrillation look?

A

A chaotic, fas rhythm, but the wave affected would be the P wave, which represents the start of atrial depolarisation.

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12
Q

How are the ventricles affected by Atrial Fibrilation?

A

The AV node electrically isolated the Ventricles, preventig the self-sustaining circuits from spreading from the atrium to the ventricles. The ventricles will still contract in a coordinated mannor, but will be slower as the action potnetial that causes them to contract no longer comes from the SA node, but instead the AV node.

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13
Q

What is the slower rate of ventricles contraction during atrial fibrillation called?

A

Idiopathic Ventricular Rate - how the vetricels work in the absence of the SA node - they work via the AV node.

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14
Q

What are the differnet types of Atrial Fibrillation?

A

Paroxysmal AF
Persistent AF
Ling-standing AF
Permanent AF

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15
Q

What is Paroxysmal AF?

A

Episodes of atrial fibrillation that come and go and usually stop within 48 hours without any treatment, but the patient is still as prone to stroke as the other AF.

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16
Q

WHat is Persistent AF?

A

Each episode of AF lasts for more than 7 days before resolving on its own (will last less than 7 if treated)

17
Q

What is long-standing AF?

A

COntinuous AF for a year or longer

18
Q

What is permanent AF?

A

Present all the time, either can’t be treated or there is no suitable treatment available.

19
Q

Symptoms of Atrial Fibrillation include:

A

Can be asymptomatic especially in the elderly.

  • Palpitations
  • Tiredness
  • Brethlessnes
  • Dizzines
  • CHest pain
20
Q

When will Atrial Fibrillation be suspected?

A

Will be suspected if the person has a stroke or TIA

21
Q

What is the Epidemiology of AF?

A

more common in over 65
more common in women
more common in those with other conditions like hypertension, atherosclerosis, heart valve issues.

22
Q

What is the progosis of AF?

A

Generally good with treatment, not ususally life threatning.

Risk of heart failure if ventricels work too hard, and can lead to stroke if left untreated.

23
Q

WHat are the goals of management of AF?

A

Establish the diagnosis of AF
Control and prevent symptoms by controlling the ventricular rate or the atrial rhythm
Prevent stroke

24
Q

How would we diagnose AF?

A

Using an ECG. If Paroxymal or persistent AF, can use a monitor attached for 24 hours or a week to get the diagnosis.

25
Q

Treatment of AF: when would the patient need to be admitted to hospital?

A

If they had a stroke or heart failure

26
Q

What are the possible treatments of AF and how do we choose?

A

Depending on the underlying causes and triggers:

  1. Rate control
  2. Rhythm control
  3. Stroke prevention
27
Q

What are the drugs for controling the rate and how do they work?

A

These don’t effect the electrical firing, only the rate. They are the recommended for most people:

1) Beta-blockers e.g. Atenolol, propranolol
2) Rate-limiting calcium-channel blockers e.g. verapamil, diltiazem (more s.e.)
3) Digoxin monotherapy: this is for people with non-paroxysmal AF who are sedentary.

28
Q

What are the Rhythm control treatment and when are these used?

A

These are recommended in people with new-onset AF within 48 hours of presentation. This is carried out in specialist care:

1) Pharmacological cardioversion
2) Electrical cardioversion
3) Surgical cardioversion

29
Q

What is the pharmacological cardioversion treatment?

A

Rhythm control treatment:
Flecainide IV loading dose then oral dosing.
Amiodarone is another option but has many side effects.

30
Q

What is the Electrical Cardioversion treatment?

A

Rhythm control treatment: similar to defibrillation and is not pleasent. The patient would have to be sedated or on a short acting anaesthetic. It is a short procedure that would last about 10 mins, where the chest wall has an electric shock.

31
Q

What is Cardioversion Surgery?

A

Rhythm control treatment:
Sometimes used where medication hasn’t worked or isn’t tolerated.
Catheter Ablation - normally carried out via a vein in the groin or wrist, and the area of the heart creatining the abnormal electrical activity is destroyed with radiofrequency energy.

32
Q

When would a pace maker be fitted?

A

If the area casuing the abnormal rhythm was the AV node to resotre sinus rhythm.

33
Q

What is the Virchow’s Triad in stroke prevention?

A
  • Changes in vessel wall
  • Changes in the pattern of blood flow
  • Changes in the constituents of blood (e.g. pro-thrombotic)
34
Q

How does Atrial Fibrilation lead to a stroke?

A

Stagnation (lack of flow) of blood in the atria and incomplete ventricular emptying will lead to clot formation, creating a risk of embolism in the brain (stroke) The risk is x17 greater in people with AF.
more than 20% of strokes are related to AF.

35
Q

What is the score of the Stratification list that indicated that the patient will need treatment?

A

Score of 2 or more = anticoagulation recommended.

36
Q

When would anticoagulation therapy not be recommended in the Stratification list?

A

A score of 0, or 1 if female

37
Q

What treatment should NOT be offered for stroke prevention in AF?

A

Anti-platelet drugs.

38
Q

What is the VItamin K antagonist treatment? What are the disadvantages and advantages?

A

Anticoagulagulant: Warfarin
Disadvantage: Many interactions, require regular INR checks that may be a hassle for some patients, there is a risk of bleeding
Advantages: Reversible using Vitamin K, levels in the body can be tested easily with INR checks,

39
Q

What is the other anticoagulant treatemtn used? Disadvantages and Advantages?

A

NOACs, and DOACs (direct/non-direct acting oral anticoagulants)
Disadvantages: Shorter half life, so a missed dose will increase risk of stroke, can’t monitor levels in the blood like Vit K antagonists, risk of bleed, difficult to reverse effects of too much.
Advantages: Standard dosing which isn’t changed very often. No INR involved, less interactions than warfarin.

PH2113 The Heart (17 decks)

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