Atrial Fibrillation

Question 1

causes of a fib

Answer 1

acute causes:

• cardiac: CHF, cardiomyopathy, MI
• pulmonary: PE
• metabolic: thyroid disease
• drugs: alcohol
• neurogenic: stroke

chronic causes:

• cardiac: HTN, ischemia, valvular disease, cardiomyopathy
• metabolic: hyperthyroidism
• other: increased age, OSA, obesity

Question 2

assessing anticoagulation in a fib

Answer 2

CCS algorithm CHADS-65:

OAC if any of:

• CHF
• HTN
• Age >65
• Diabetes
• Prior stroke or TIA

Antiplatelet if:

• CAD
• peripheral artery disease

Question 3

investigations for a fib

Answer 3

• CBC, INR, renal and liver panels, TSH, fasting glucose, lipids
• 12 lead ECG
• echo

Question 4

management of a fib

Answer 4

RATE CONTROL

• start with rate control
• history of MI or CHF: beta blockers
• no hx of MI: beta-blocers OR diltiazem

RHYTHM CONTROL
- discuss with cardiology

CARDIOVERSION