Atrial Fibrillation

Nota:

• NOT FROM LECTURE NOTES

1. Post-Operative (Open Heart Surgeries)
2. Pericarditis
3. "Lone" AF

   Nota:

   • NO RISK FACTORS at all and still has AF...
4. Cardiac Causes
   1. Hypertension
   2. Heart Failure
   3. Ischaemic Heart Disease
   4. Rheumatic Heart Disease
   5. Sinus-sinus syndrome

      Nota:

      • Tachy-Brady syndrome
   6. Wolff-Parkinson-White Syndrome
   7. Cardiomyopathy
5. Non Cardiac Causes
   1. Acute Infections
   2. Electrolyte depletion
   3. Lung Carcinoma
   4. Pleural Effusion
   5. Pulmonary Embolism

1. It is a type of Arrhythmia
   1. Atria are fibrillating, not a normal contraction ---> STAGNANT Blood Flow
      1. Leading to a rapid, irregular Ventricular Rate
         1. Decreased Ventricular filling and output
            1. This leads to these SYMPTOMS
               1. Fatigue
               2. Shortness of Breath
               3. Chest discomfort
               4. Palpitations
               5. Feeling faint
      2. Blood Clot
         1. Stroke
         2. Heart Attack
         3. Pulmonary Embolism

            Nota:

            • Blood Clot in the Lung

1. Medicines
   1. Beta-Blockers & Non-dihydropyridine CCB are first line

      Nota:

      • Metoprolol, Atenolol, Propranolol, Carvedilol Diltiazem, Verapamil. All DECREASE BP. Slow the HR 
   2. Digoxin - Second line

      Nota:

      • HR often increase with exercise
2. Procedures
   1. Pacemakers

      Nota:

      • Prevents Heart from going too slow but can do nothing with heart going too fast. That is why antiarrhymic drugs are given.
   2. AV node ablation

      Nota:

      • A type of surgery that involves burning.

1. Medicines

   Nota:

   • Most likely prescribed these medications for sinus rhythm maintenance or preventing AF occuring
   1. Amiodarone

      Nota:

      • Best Efficacy/Effectiveness. Problems: Toxicity in brain, liver, kidney, thyroid, skin.
   2. Flecainide
   3. Pill In Pocket
2. Cardioversion

   Nota:

   • Restarting the heart.  Very successful - AF to normal sinus rhythm 

1. Paroxysmal AF (Self-Terminating)

   Nota:

   • <7 days (Most resolve within 24 hours)
   1. Rhythm Control FIRST
      1. Rate Control if rhythm fails
2. Persistent AF (Not Self-Terminating)

   Nota:

   • > 7 days - sustained AF that terminates with cardioversion
   1. Rate OR Rhythm Control depending on conditions

      Nota:

      • Rhythm first in patients who are: Symptomatic Younger (<65) Presenting for first time with Lone AF Secondary to precipitant Congestive Heart Failure 
      • Rate first in patients who are: Over 65 With Coronary Heart Disease Contraindications to anti-arrythmic drugs Unsuitable for cardioversion 
      1. Try other if previous fails
3. Permanent AF (Cannot go back to Normal)

   Nota:

   • Persists for more than a year, cardioversion has failed or not even attempted
   1. Rate Control FIRST
      1. Rhythm Control (if rate fails)

         Nota:

         • Opposite of Paroxysmal  methods Karo :)
4. New Onset of AF
   1. Patient is Hemodynamically Stable
      1. Anticoagulated INR 2-3 for >3 weeks
         1. Cardioversion
         2. Rate Control
      2. Not anticoagulated INR <2 for 3 weeks
         1. Warfarin and Rate Control
         2. Cardioversion
5. Recurrent AF

   Nota:

   • I don't know if we've learnt it this way...
   1. Minimal Symptoms
      1. Warfarin and Rate Control
         1. No prevention. No Anti-arrythmic drugs
   2. Disabling Symptoms
      1. Warfarin and Rate Control
         1. Anti-arrythmic drugs for prevention