7961312
Descripción
Fichas por Ashutosh Kumar, actualizado hace más de 1 año
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Creado por Ashutosh Kumar
hace más de 7 años
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| Pregunta | Respuesta |
| Atrial fibrillation prevalence influenced by: | Atrial fibrillation prevalence: Increases with age, particularly over 50. Presence of cardiovascular disease increases risk. |
| AF definition and consequences: | AF definition and consequences: Rapid irregular contractions of the atria and an irregular ventricular response. Main consequences are; decrease in cardiac output and the formation of thrombus within the atria. Risk of stroke five times higher than without AF. |
| Two important management issues in AF: | Two important management issues in AF: Symptom management. Assessment and management of thromboembolic risk |
| Aims of treatment of AF: | Aims of treatment of AF: Provide relief from symptoms if present. Prevent thromboembolic stroke. Prevent other serious complications such as heart failure. |
| Stepwise approach to AF: | Stepwise approach to AF: Confirm the diagnosis with an ECG. Consider if urgent referral to secondary care is required. Determine the type of AF (e.g persistent, paroxysmal or permanent). Symptom management. Assess stroke risk to determine if antithrombotic treatment is required. |
| Confirm the diagnosis: | Confirm the diagnosis: Take comprehensive history. Check when symptoms started, how often and how long. Assess severity of symptoms and any associated features that may suggest an underlying cause. Ask about precipitating factors such as stress, alcohol and exercise. CVS examination. ⅓ asymptomatic. |
| ECG use in AF: | ECG: To confirm diagnosis. May show evidence of underlying abnormalities. Other conduction abnormalities. Assessment of QT interval for amiodarone, sotalol and disopyramide. |
| Other tests: Blood test: Echocardiography: Chest X-ray: Holter monitoring: | Other tests: Blood test: TSH for hyperthyroidism FBC for anaemia and infection Electrolytes for metabolic Creatinine/eGFR for renal function Glucose to exclude diabetes LFT prior to anticoagulation or if high alcohol intake INR if warfarin to be initiated Echocardiography: All patients newly diagnosed with AF should be referred- assess thromboembolic risk esp with LVF Chest X-ray- SOB cases Holter monitoring- paroxysmal symptoms and to assess effectiveness of rate control |
| Consider if urgent referral required: | Consider if urgent referral required: Pulse rate > 150 or SBP <90 Chest pain, increasing SOB, severe dizziness or loss of consciousness Complications of AF; TIA, stroke, acute ischemia or heart failure |
| Referral or discussion with cardiologist: | Referral or discussion with cardiologist: Probable paroxysmal AF ECG abnormalities Known or suspect valvular disease Ongoing symptoms despite appropriate rate control treatment |
| Determine type of AF: | Determine type of AF: Paroxysmal AF: Characterized by recurrent episodes of AF that last less than seven days and resolve spontaneously within that time. Rhythm control. Persistent AF: Characterized by recurrent episodes of AF that last more than seven days and do spontaneously resolve within that time. Rate or rhythm control-patient individual situation. Permanent AF: Present for one year of more and cardioversion has been unsuccessful or not attempted. Rate control. |
| Choice between rate or rhythm control is guided by: | Symptom management: Choice between rate or rhythm control is guided by: Type of AF Age Comorbidities Presence or absence of symptoms Patient preference |
| Rate control for: | Rate control for: Asymptomatic AF Permanent AF Rate control medicines: Beta blockers CCB (verapamil or diltiazem) Digoxin Rate control target: ≤ 80 at rest and ≤ 115 during moderate walking |
| Rhythm control (restore and maintain sinus rhythm) (refer to cardiologist): | Rhythm control (restore and maintain sinus rhythm) (refer to cardiologist): Paroxysmal AF Persistent AF Structural heart disease Rhythm control medicines: Beta blockers Sotalol (beta blocker, class 3) Flecainide (class 1) Amiodarone (class 3) 1% risk of exacerbating AF; treatment individualized and fully explained to patient. Radiofrequency ablation option as well (medicines not helping or lifestyle). |
| Assess thromboembolic risk and stroke risk to determine appropriate antithrombotic treatment: | Assess thromboembolic risk and stroke risk to determine appropriate antithrombotic treatment: Five fold increase in risk of stroke. Risk regardless type of AF. Presence of other variables affects risk. Bleeding risk should be assessed to help assess risk benefit for anticoagulant therapy. CHADS score ≥ 2 start anticoagulant. If less than 2 then do CHADSVASC. Aspirin if inappropriate to anticoagulate. Consider patient preference, monitoring requirements and comorbidities. If anticoagulation needed; warfarin for all with hemodynamically significant valvular disease or prosthetic valves; dabigatran for rest. |
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