MP323 - AF

Question 1

what is atrial fibrillation

Answer 1

supraventricular tachycardia characterised by disorganised atrial electrical activity

Question 2

symptoms of AF

Answer 2

• breathlessness/difficulty breathing
• dizziness/lightheaded/feeling faint
• palpitations
• tiredness/weakness
• chest discomfort
• difficulty exercising

Question 3

clinical tests to diagnose AF

Answer 3

ECG
holter monitor
loop recorder
echo

Question 4

potential differential diagnosis

Answer 4

diabetes
hyperthyroidism
anaemia
renal function
infections
high cholesterol

Question 5

management of AF

Answer 5

• alleviate symptoms
• manage complications to irregular heart rate
• reduce risk of embolic stroke
• reduce risk of HF/LVSD

Question 6

CHA2DS2-VASc score risk factors

Answer 6

chronic heart failure
hypertension
age (>65 or >75 (2 points))
diabetes
stroke/TIA (2 points)
VA vascular diseases (IHD/PAD)
sex (female)

Question 7

treatment options against clots

Answer 7

warfarin - vitamin K antagonist
DOAC
factor Xa inhibitor
direct thrombin inhibitor

Question 8

alleviate symptoms - rate control

Answer 8

• control the ventricular rate using AV blocking drug
• choice of AV blocking drug is based on left ventricular systolic function

Question 9

AV blocking drugs

Answer 9

rate-limiting BBs
non-dihydropyridine CCBs (verapamil)
digoxin

Question 10

alleviate symptoms - rhythm control drugs

Answer 10

class III (amiodarone)
class IV (flecainide)

Question 11

amiodarone as a drug

Answer 11

• acts by blocking potassium channels
• effective but toxicity is a concern
• half-life is 42 days
• inhibition of T4 and T3 entry into the peripheral tissue
• preferred in patients with LVSD
• chemical cardioversion

Question 12

flecainide as a drug

Answer 12

• maintain sinus rhythm or chemical cardioversion
• significant coronary artery disease is contraindicated
• can be used as ‘pill-in-the-pocket’ approach