Atrial fibrillation

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Community Based Medicine Fichas sobre Atrial fibrillation, creado por Liam Musselbrook el 14/02/2017.
Liam Musselbrook
Fichas por Liam Musselbrook, actualizado hace más de 1 año
Liam Musselbrook
Creado por Liam Musselbrook hace casi 8 años
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Pregunta Respuesta
How is atrial fibrillation characterised? Irregularly irregular ventricular pulse and loss of association between the cardiac apex beat and radial pulsation
Define acute AF Onset within the previous 48 hours
Define paroxysmal AF Spontaneous termination within seven days and most often within 48 hours
Define persistant AF Not self-terminating; lasting longer than seven days, or prior cardioversion
Define permenant AF Lasts over a year Is not successfully terminated by cardioversion, when cardioversion is not pursued or has relapsed following termination
What are the most common causes of AF? Coronary heart disease Hypertension Valvular heart disease Hyperthyroidism
How might AF present? Breathlessness/dyspnoea Palpitations Syncope/dizziness Chest discomfort Stroke/transient ischaemic attack (TIA)
Differential diagnoses for AF Atrial flutter Atrial extrasystoles Supraventricular tachyarrhythmias (SVTs) Atrioventricular nodal re-entrant tachycardia Wolff-Parkinson-White syndrome Ventricular tachycardia
Investigations for suspected AF ECG - 24-hour ambulatory ECG if undetected, suspected paroxysmal TFTs, FBC, U&Es, LFTs and coagulation screen CXR Echo (if meets risk criteria) Head CT/MRI if stroke/TIA
When is routine referral indicated? <50 years of age Suspected paroxysmal AF Uncertainty - rate vs rhythm control Primary care drugs contra-indicated or have failed to control symptoms Valve disease or left ventricular systolic dysfunction on echocardiography WPW syndrome or a prolonged QT interval
Rate control therapy is first line, except in people: - Whose AF has a reversible cause. - Who have heart failure thought to be primarily caused by AF - With new-onset AF - For whom a rhythm control strategy would be more suitable based on clinical judgement
What do you offer as rate control therapy? Initial therapy - either beta-blocker or rate-limiting CCB Consider digoxin monotherapy for non-paroxysmal AF only if they are sedentary If failed, combination (2): beta-blocker, diltiazem, digoxin
Rhythm control: cardioversion a) when is electrical offered? b) what therapy is started and maintained after? a) AF that has persisted for longer than 48 hours b) Amiodarone, 4 weeks before and continuing up to 12 months after to maintain sinus rhythm
Drug treatment for long-term rhythm control a) what is normally 1st line? b) What drug for people with left ventricular impairment or heart failure a) Beta-blocker b) Amiodarone
When is dronedarone rhythm control therapy recommended? 1st line therapy fails or 1 of the following RFs: HTN needing 2 different drug types, DM, previous TIA, stroke, left atrial diameter ≥50mm, or ≥70yrs * No LV impairment or HF
When is left atrial ablation offered? Drug treatment failed Paroxysmal AF Consider for persistent AF Consider + other cardiothoracic surgery for symptomatic AF
When would you consider pacing and atrioventricular node ablation? Permanent AF with symptoms or left ventricular dysfunction thought to be caused by high ventricular rates Paroxysmal AF or HF caused by non-permanent AF
How is risk of stroke assessed?
What score is classed as low risk? When is anticoagulation therapy offered? Men = 0 Women = 1 Anticoagulation therapy is offered in scores of 2 and above
What is used to assess bleeding risk in people who are starting or have started anticoagulation?
What drugs may be used as anticoagulation therapy? Apixaban Dabigatran Rivaroxaban Edoxaban Vitamin K antagonist (eg, warfarin)
What drug must specifically not be offered as monotherapy solely as stroke prevention in people with AF? Aspirin
Complications of AF Increases risk of stroke six-fold Can precipitate acute HF and aggravate established heart failure Cardiomyopathy
What measures can be taken to help prevent AF? Smoking cessation Alcohol reduction/avoidance Caffeine reduction/avoidance
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