- electrical cardioversion (technique where deliver high voltage across the atria to reset the rhythm to voltage 0 of action potential) - anti arrythmatic drugs

AF Flashcards by Caitlyn Gallagher

How do you identify Left Ventricular Hypertrophy on an ECG?

very tall R waves
ST depression
Over 3 leads

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What are signature AF ECG landmarks?

Absence of P waves

-Irregularly irregular

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What are the three types of AF?

paroxysmal, persistent or permanent

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What is paroxysmal AF usually associated with?

normal hearts

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What is chronic AF usually associated with?

heart disease

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What are the characteristics of sustained AF?

It is facilitated by increased parasympathetic tone.

decreased refractory periods
shorter wave lengths
making it easier for AF to sustain itself

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What is the mechanism of AF?

Atria is firing away rapidly
muscle layer in atrium is often diseased
caused by multiple wavelets of re-entry

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How do we stop AF?

electrical cardioversion (technique where deliver high voltage across the atria to reset the rhythm to voltage 0 of action potential)
anti arrythmatic drugs

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What are the characteristics of paroxysmal AF?

paroxysmal and lasting less than 48 hours

- often recurrent

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What are the characteristics of persistent AF?

an episode of AF lasting more than 48hours, which can still be cardioverted to NSR
unlikely to spontaneously revert back to NSR

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What are the characteristics of permanent AF?

-inability to restore NSR

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What are some of the associated diseases/causes of AF?

-hypertension
-congestive heart failure
-CHD
-obesity
Thyroid disease
-Genetic
-cardiac valve disease

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What is Lone (idiopathic) AF

Absence of any heart disease and no evidence of ventricular dysfunction
essentially dont know what causes it

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What are the symptoms of AF?

palpitations
pre syncope
syncope
chest pain
dyspnoea
sweatiness
fatigue
asymptomatic

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How does AF look on an ECG?

fast atrial rate
irregularly irregular
absence of P waves
Presence of f waves

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What is the ventricular rate dependant on in AF?

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Av node conduction properties
sympathetic and parasympathetic tone
presence of drugs which act on the AV node

What are some abnormal patterns of AF?

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Alow VR rate with periods of fast VR. A pacemaker may be needed to allow control of fast VR. It could result in complete heart block
-treat with pacemaker and B blocker

What is pseudo-regularisation AF?

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a fake regular heart rate AF

What are some important points to consider about AF?

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decreased diastole leads to reduced CO
can result in congestive HF especially in diastolic dysfunction
VR less than 60 suggest AV conduction disease

What are the management options for AF?

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rhythm control or rate control
anti-coagulation for both approaches if high risk for thromboembolism
manage risk and symptoms

What are the treatment options to slow down AV node conduction and therefore slow rate in AF ?

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digoxin, B blockers, verapamil, diltilazem

-use these drugs alone or in combination

What are the treatment options to revert AF to sinus rhythm?

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antiarrythmatic drugs

- direct current cardioversion

What are the treatment options to maintain normal sinus rhythm?

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anti-arrythmatic drugs
catheter ablation of atrial focus/ pulmonary veins
surgery

What are the four classes of antiarrhythmatic drugs?

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1, 2, 3 ,4

What is a class 1 anti- arrythmatic drug?

- reducing Na channel current | - Lignocaine, quinidine, felcainide, propadenone

What is a class II ant arrythmatic drug?

- adrenergic antagonists | - propanolol

What is a class III anti arrythmatic drug?

- action potential prolongation | - aminodarone, sotalol, dronedarone

What is a class IV anti arrythmatic drug?

- ca channel antagonists | - verapamil

what puts you at a high risk of thromboembolism?

- valvular heart disease - age above 75 especially if female - hypertension - heart failure - previous thromboembolism or stroke - CAD or diabetes and above 50y/old - Thyrotoxicosis

Should you have any of risk factors for thromboembolic disease then what medication should you be on?

Anticoagulants ie warfarin, rivaroxaban

What are indications for anticoagulation in valvular AF?

-mitral valve disease: Mitral Stenosis and Mitral regurgitation

What are indications for anticoagulation in non valvular AF?

- age above 75 - hypertension - HF - previous stoke/thromboembolism - CAD/DM - Diabetes

What is indicated by a 1 or 2 on the CHA2DS2-VASc score?

1- anticoagulation should be considered | 2-they should be on anticoagulation

when would radiofrequency ablation in AF be used?

- To maintain SR by ablating AF focus | - For rate control by ablation of the AV node to stop fast conduction to the ventricles

What is an atrial flutter?

-regular and regular form of atrial tachycardia -usually paroxysmal -sustained by a macro-re-entrant circuit -circuit is confined to the rigtht atrium -episodes can last from seconds to years -chronic atrial flutter usually progresses to atrial fibrillation May result in thromboembolism

What are the characteristics on an ECG in atrial flutter?

- atrial 300bpm - ventricular rate usually half that - saw tooth P wave pattern - normal QRS - normal conduction sometimes 2:1 - regular rhythm but may be variable

What are the treatment options for atrial flutter?

-radiofrequency ablation -pharmacological therapy -cardioversion warfarin for thromboembolic prevention

What are the two goals in atrial flutter?

- -Terminate the flutter and prevent recurrence | - Control the ventricular response during the arrhythmia

What are the pharmacological therapies used in AF in aim of?

- slow the Ventricular rate - restore sinus rhythm - maintain sinus rhythm once converted

AF Flashcards

(39 cards)