7674889
Descripción
Fichas por Liam Musselbrook, actualizado hace más de 1 año
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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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