Atrial Fibrillation | Cheat Sheet

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

493

Pages:

3
Author:

Mariam A. A.

Atrial Fibrillation Most common form of tachycardia Most common form of irregular tachycardia Continuous rapid activation of the atria Risk Factors Cardiovascular origin: HTN CAD HF Valvular heart disease Cardiomyopathy Presence of other arrythmias Non-cardiovascular origin: DM Thyroid disease Alcohol misuse Smoking Certain cancers: Primary lung cancer involving the pleura and pericardium Clinical features Palpitations Tachycardia Irregular pulse Types Type Description Self-terminating episodes Paroxysmal AFib Usually within 48 hours May continue for up to 7 days Persistent AFib Longer than 7 days Longstanding persistent AFib Continuous AFib for 1 year or longer and is decided to rhythm control Permanent AFib Rhythm control not used because the patient accepts to remain AFiB Investigations ECG Thyroid profile Hyperthyroidism Thyrotoxicosis Echocardiogram Important for excluding risk factors and pathologies associated with AFiB E.g. valvular disease Thrombus in LA -> more accurately detected via a TTE Serum urea and electrolytes Kidney function Influences subsequent management and drug choice and dosing Serum transaminases Alcohol use -> risk factor for AFiB Prolonged ECG monitoring Fasting BSL or HbA1c Screening for sleep disordered breathing Management Unstable AFiB: AFiB + AMS, HoTN, angina or SOB (LF failure) Synchronized DC Begin with 120 to 150 J (biphasic) Stable AFiB Without evidence of hemodynamic compromise Less than 48 hours duration: Rhythm control with drugs or DC Correct hypokalaemia with premixed 10 mmol K+ 100 mL 5% dextrose over 30 minutes Correct hypomagnesaemia (esp. in alcoholics) with Mg2SO42 Give amiodarone IV over 30 minutes followed by an infusion over 24 hours Give LMWH If above unsuccessful -> electrical cardioversion Assess bleeding and stroke risk for need for anticoagulation DOACs (apixaban) or warfarin More than 48 hours duration or unclear duration Only rate control do not attempt dug cardioversion or elective DC reversion Contraindicated prior to full anticoagulants for at least three weeks -> increased risk of thromboembolism -> stroke etc. LMWH Rate control PO -> aim for 110/min BB -> first line Diltiazem Digoxin