#Phase 2.1: CardioResp > AF > Flashcards

AF Flashcards

(51 cards)

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1
Q

What are the most common causes of AF? (5 things)

A
  1. S – Sepsis
  2. M - Mitral Valve Pathology
  3. I – Ischaemia HD
  4. T - Thyrotoxicosis
  5. H - HTN

(mrs. SMITH has AF)

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2
Q

What is up with the Atria contraction in AF? (3 things)

A
  1. Uncoordinated
  2. Rapid
  3. Irregular
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3
Q

Why is the atria contraction clarted in AF?

A

Disorganised electrical activity overriding normal SA node activity

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4
Q

How is the pathophysiology of AF reflected in a ECG? (4 things)

A
  1. Irregular rhythm
  2. QRS thinning
  3. P waves missing (lack of coordinated electrical activity)
  4. Isoelectric baseline missing
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5
Q

What does the disorganised electrical activity in atria in AF also lead to?

A

Irregular conduction of electrical impulses to ventricles

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6
Q

What does the irregular conduction of electrical impulses to ventricles caused by AF lead to? (4 things)

A
  1. Irregularly irregular ventricular contractions
  2. Tachycardia
  3. Heart failure bc poor filling of ventricles @ diastole
  4. Risk of stroke
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7
Q

How can AF cause stroke? (4 steps)

A
  1. Uncontrolled organised movement of atria –> thrombus (clot)
  2. Thrombus mobilizes –> embolus
  3. Embolus travels from atria –> ventricle –> aorta –> carotid arteries –> brain
  4. Embolus lodges in cerebral arteries –> ischaemic stroke
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8
Q

Where is the most common site of blood stagnating in the heart?

A

Left atrium, esp atrial appendage (outpouching ting)

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9
Q

What are the clinical features of AF? (6 things)

A
  1. Palpitations
  2. Usually asymptomatic
  3. SOB
  4. Syncope
  5. Irreg irreg pulse
  6. Other assoc conditions symptoms (e.g stroke / sepsis)
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10
Q

What are the differentials of an irregularly irregular pulse? (2 things)

A
  1. AF
  2. Ventricular ectopics
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11
Q

How do you differentiate between AF and Ventricular ectopics? (which both have an irreg irreg pulse)

A

ECG

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12
Q

What diagnosis would a irreg irreg pulse that disappears at high HR (e.g. @ exercise) suggest? (either AF or Ventricular ectopics)

A

Ventricular ectopics bc they disappear when HR goes over a certain threshold

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13
Q

What are the ECG features of a AF? (4 things)

A
  1. Irreg irreg tachycardia rhythm
  2. QRS thinning
  3. P waves missing
  4. Isoelectric baseline missing
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14
Q

What are the principles of treating AF? (2 things)

A
  1. Rate / rhythm control
  2. Anticoag. to prevent stroke
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15
Q

Why is Rate control important in AF?

A

Bc high rate –> less time for ventricles to fill up –> reduced CO

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16
Q

What is the aim of Rate control in AF?

A

Get HR under 100 –> extends diastole time for ventricles to fill up

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17
Q

According to NICE, every AF patient should have Rate control as their first line treatment except when? (4 things)

A
  1. Cause of AF is reversible
  2. New onset AF (last 48 hrs)
  3. AF is causing HF
  4. Still symptomatic after rate controlled
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18
Q

What are the options for Rate control in AF? (3 things)

A
  1. Beta blocker (first line) (atenolol 50-100mg once daily)
  2. Calcium channel blocker (e.g diltiazem) (don’t give in HF)
  3. Digoxin (only in sedentary ppl cah needs monitoring + toxicity risk)
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19
Q

Which AF patients should be offered Rhythm control? (4 things)

A
  1. Cause of AF is reversible
  2. New onset AF (last 48 hrs)
  3. AF is causing HF
  4. Still symptomatic after rate controlled

(basiclly when they shudnt have rate control)

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20
Q

What is the aim of Rhytm control in AF?

A

Return patient to Normal Sinus Rhythm

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21
Q

What are the options for Rhythm control in AF? (2 things)

Study These Flashcards
A
  1. Cardioversion
  2. Long term MEDICAL rhythm control
22
Q

When should Cardioversion be given IMMEDIATELY in AF? (2 things)

Study These Flashcards
A
  1. AF present for less than 48 hrs
  2. Severely haemodynamically unstable
23
Q

When should Cardioversion be given but DELAYED in AF? (2 things)

Study These Flashcards
A
  1. AF present for more than 48 hrs
  2. Pt haemodynamically stable
24
Q

What is the point of DELAYED cardioversion in AF?

Study These Flashcards
A

Allows pt to be anticoagulated for 3 wks first

25
Why is anticoagulation important before cardioversion in AF?
Bc pt might have a clot, n returning them to Normal Sinus Rhythm might mobilise clot --\> stroke
26
What are the 2 types of Cardioversion in AF?
1. Pharmacological Cardioversion 2. Electrical Cardioversion
27
What Pharma Cardioversion is first line for AF? (according to NICE) (2 things)
1. Flecanide 2. Amiodarone
28
What is the aim of Electrical Cardioversion in AF?
To shock heart bk into Normal Sinus Rhythm
29
What does Electrical Cardioversion in AF involve? (2 things)
1. Sedation / GA 2. Cardiac defibrillator --\> deliver controlled shocks
30
What are the types of Long term MEDICAL rhythm control options in AF? (3 things)
1. Beta blockers (first line) 2. Dronedarone (second line) (given after successful cardioversion) 3. Amiodarone (for pt w HF / L Ventricular dysfunction
31
What is Paroxysmal AF?
When AF comes n goes in episodes (not more dan 48hrs)
32
How should Paroxysmal AF be managed?
1. Anticoag based on CHADSVASc score 2. “Pill in pocket” approach (have pill to stop AF for when dey need)
33
What must patients have to qualify for the “Pill in pocket” approach in Paroxysmal AF? (3 things)
1. Infrequent episodes 2. No underlying structural heart disease 3. Be able to identify when dey r in AF
34
What is the pill in the “Pill in pocket” approach for Paroxysmal AF?
Flecanide
35
What is the risk of an AF pt WITHOUT anticoag. suffering a stroke?
5% stroke risk per year
36
What is the risk of an AF pt WITH anticoag. suffering a stroke?
1-2% stroke risk per year
37
What is the risk of a patient on anticoag suffering a serious bleed?
3% risk of serious bleed each year
38
What types of Anticoagulant are used for AF? (2 things)
1. Warfarin 2. NOvel AntiCoagulants (NOACs)
39
How does Warfarin act as an anticoagulant? (2 points)
1. Vit K antagonist (vit K = important for clotting factors) 2. Prolongs prothrombin time (time it takes blood to clot)
40
What measurement is used to assess how anticoagulated a patient is by Warfarin?
INR (international normalised ratio)
41
What is the INR a calculation of?
Prothrombin time in comparison w normal adult
42
What does an INR of 1 or 2 suggest?
INR: 1 = normal prothrombin time INR: 2 = prothrombin time is twice that of normal adult (watery)
43
What are examples of NOACs (anticoag used in AF)? (3 things)
1. Apixaban (twice daily) 2. Rivaroxaban (once daily) 3. Dabigatran (twice daily)
44
If there’s uncontrolled / life threatening bleeding from using NOACs, how can you reverse their effects?
1. Andexanet alfa (for apixaban n rivaroxaban) 2. Idarucizumab (for dabigatran)
45
What are the advantages of NOACs over Warfarin? (BMJ) (4 things)
1. No monitoring needed 2. No major interaction 3. Better at preventing strokes in AF 4. Less risk of bleeding
46
What is used to see the risk of a AF pt has a risk of stroke and should be anticoagulated?
CHA2DS2Vasc score
47
What does a score of 0,1,1+ CHA2DS2Vasc score suggest?
``` 0 = no risk of stroke, no anticoag. 1 = consider anticoag. 1+ = offer anticoag. ```
48
What do the letters in CHA2DS2Vasc mean and what do they score?
* C – Congestive HF (1) * H – HTN (1) * A2 – Age \>75 (Scores 2) * D – Diabetes (1) * S2 – Stroke / TIA previously (Scores 2) * V – Vascular disease (1) * A – Age 65-74 (1) * S – Sex (female) (1)
49
What is the opposite of the CHA2DS2Vasc score?
HAS-BLED
50
What does the HAS-BLED score show?
Pt risk of BLEEDING while on anticoag.
51
What do the letters in HAS-BLED mean and what do they score?
• H – Hypertension (1) • A – Abnormal renal / liver function (1 each) • S – Stroke (1) • B – Bleeding (1) • L – Labile INRs (labile = unstable) (whilst on warfarin) (1) • E – Elderly (65+) (1) • D – Drugs or alcohol (1 each) Score of 3+ = high risk of bleeding
#Phase 2.1: CardioResp
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