AF

Question 1

Definition?

Answer 1

Atrial Fibrillation is a supraventricular tachyarrhythmia, characterised by uncoordinated atrial electrical activity.

Question 2

Types?

Answer 2

Paroxysmal <7 days

Persistent/permanent-> 7 days-remodelling constant

Question 3

Risk factors?

Answer 3

• Older
• DM
• HT
• CHF
• Valvular heart disease
• Coronary artery disease
• Other arrhythmias
• Cardiac/thoracic surgery
• Hyperthyroidism

Question 4

For Acute? PARASITE

Answer 4

Pulmonary disease
	Anaemia
	Rheumatic heart disease
	Atrial myxoma
	Sepsis
	Ischaemia
	Thyroid disease
	Ethanol

Question 5

Differentials and features?

Answer 5

• Atrial flutter-sawtooth ECG
• Wolff-Parkinson-White Syndrome-younger-Delta wave and shortened PR interval
• Atrial tachycardia-abnormal P waves-usually in COPD pts

Question 6

Epidemiology?

Answer 6

Age: older
Sex: male
Ethnicity:
Prevalence:

Question 7

Clinical Presentation?

Answer 7

• Asymptomatic
• Palpitations, Dizziness, syncope, fatigue, SOB
• Murmurs
• Tachycardia and irregularly irregular pulse
• Apex-pulse deficit
• Pulmonary oedema
• TE events
• Ventricular tachycardia

Question 8

Pathophysiology?

Answer 8

• Supra ventricular tachycardia-atria don’t contract in a synchronised way and quiver
• LA-stasis-clotting-embolization-stroke
• Trigger-ectopic foci-impulse generated from pacemaker cells in place other than -SAN-usually pulmonary veins on left-fire rapidly
• AVN picks up impulses irregularly-and relays them to the ventricles irregularly
R-entry circuit-IHD, age HT-change atrial shape-diff conductivities/excitability-shorter refractory periods- shorter re-excitement and re-entry circuit-unsynchronised rhythms relayed through AVN

Question 9

Investigations-first line?

Answer 9

Cardio/resp exam-Signs of arrhythmias

Question 10

Investigations-second line?

Answer 10

• ECG-absent P waves; presence of fibrillatory waves that vary in size, shape, and timing; irregularly irregular QRS complexes
• Serum electrolytes-high or low potassium or low magnesium
• Cardiac biomarkers-elevated creatine kinase-MB or troponin with myocardial ischaemia
• Thyroid function test-suppressed TSH in thyrotoxicosis
• CXR-may show cardiomegaly, in particular left atrial enlargement; signs of heart failure; other precipitating pathology, such as pneumonia
• Transthoracic echo-may show dilated left atrium; valvular disease; low LVEF; diastolic dysfunction
• Transoesophageal echo-atrial thrombus
• Electrophysiological-Shows abnormal impulse conduction
• Exercise stress-CAD

Question 11

Management-first line?

Answer 11

Stroke prevention-anticoagulation-unless LAA occlusion
NV-NOAD’s
V-warfarin

Question 12

Management second line? 1 and 2 step drugs

Answer 12

Controlling rate-
1-CCB and beta blocker/digoxin
2-BB, diltiazem and digoxin

Question 13

Management third line? 1 and 2 step

Answer 13

Controlling rhythm-
1-Cardioversion-pharm/electrical
2-dromodarone and bb

Question 14

Management 4th line?

Answer 14

Ablation-surgical or catheter

Question 15

Management acute?

Answer 15

anticoagulation-heparin or pharm

Question 16

Management after surgery?

Answer 16

anticoagulants and rhythm control

Question 17

Second line if acute?

Answer 17

Felcainide-Class I AA-stops Na influx in AVPs
or amiodarone if no heart disease
Amiodarone if structural heart disease

Question 18

Prognosis?

Answer 18

Depends on underlying disorders

Poor if linked to MI

Question 19

Complications?

Answer 19

Acute stroke
MI
CHF
Airway disease
Ablation-surgical/catheter
Death
Bradycardia
Pro-arrhythmic drugs
Amiodarone linked pulmonary toxicity and thyroid dysfunction