List complications of AFib
- Stroke, Thromboembolism, HF
* TachyC-induced Cardiomyopathy and Critical Cardiac Ischaemia due to persistently elevated ventricular rate in AF
Compare the 3 types of AF
- Paroxysmal: Sudden episodes, stop suddenly within 2-7 days without treatment
- Persistent: Lasts >7 days, likely to need treatment
- Permanent: Long-term, HR doesn’t return to normal rhythm but treatment reduces rate
Describe and list AFib symptoms
- Most are asymptomatic, caught by chance when pulse felt (may be fast or irregular- speed/force)
- Symptoms usually start suddenly: Palpitations, Dizziness/ Syncope, Chest pains/ Angina, SoB (often 1st to present)
List alternate diagnoses to AFib
AFlutter
Atrial extrasystoles, Ventricuar ectopic beat
Sinus TachyC, SVTs
Sinus rythm with premature Atrial/ Ventricular contractions
How does AFlutter look on an ECG
Saw-tooth pattern of regular atrial activation on ECG
List investigations for AFib
FBC, Echocardiogram, ECG during AF episode
What things must be assessed in a pt presenting with AFib
Haemodynamically stable or not?
- Unstable: Admit for urgent cardioversion
- Stable: Admit or manage in primary
- Stroke risk (CHADS-Vasc tool)
- Risks/ Benefits of Anticoagulation (ORBIT tool)
AFib treatment involves Rate and Rhythm control
Outline rate control, including what to do if symptoms not controlled
- B-Blocker/ Digoxin/ Rate-limiting CCB
- If symptoms not controlled, consider increasing dose or combination therapy
- If still not controlled, refer within 4wks
How high can the HR be in AFib? What is it usually?
What is the goal of Rate control treatment?
Can be upto 180, commonly 120-60
Goal: HR<90 when resting. Pulse may still be irregular
Outline Rhythm control in AFib treatment
- Referral for Cardioversion- Reverting erratic rhythm back to normal
- Electric shock, Medication (Amiodarone) or Catheter Ablation
Outline AFlutter treatment
Similar to AFib, but AFlutter responds less well to drug treatment
Rate control;
- B-blocker or rate-controlling CCB (Diltiazem, Verapmil)
- Digoxin if not not helping or in HF
Rhythm: Electrical/ Drug/ Catheter ablation
When can’t you do cardioversion to treat AFlutter?
Don’t attempt Cardioversion if duration >48hrs or unknown, unless pt fully anticoagulated for at least 3wks
Outline the follow-up of Rate control treatment
Within 1wk of starting/ altering dose
Outline the follow-up/ monitoring of Anticoagulant treatment
If on Warfarin;
- Monitor INR daily/ alternate days until between 2 and 3 on 2 consecutive occasions, then x2/week for 1-2wks, then x1/week, then at longer intervals (e.g once every 12wks)
Calculate Time in Therapeutic Range (TTR) at each visit;
- Calculate over maintenance period of at least 6mths
- Exclude measurements during 1st 6wks of treatment
