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WEEK 19:
AF PLENARY:
| Question | Answer |
|---|---|
| definition of AF | supraventricular tachyarrythmia with uncoordinated atrial electrical activation and consequently ineffective atrial contraction |
| triggers for AF (pirates) | PE Ischemia Respiratory disease Atrial enlargement or myxoma Thyroid disease (check TSH and free T4 in first-time presenters) Ethanol (“Holiday heart” after binging) Sepsis or Sleep apnea |
| effective case identification of AF before it happens for those aged 65yrs or older | pulse checks |
| what drug should NEVER be used with AF | aspirin |
| which patients should be symptom free | people with AF should have optimal heart rate control and be symptom free |
| what should happen to patients who remain symptomatic despite optimal heart rate control | refer for specialist management |
| apart from medication what should people with AF receive | information on their condition, actively involved in all decisions around their care, and support to self-manage their long term condition |
| sensitivity refers to | proportion of people WITH AF that have a POSTIVIE TEST |
| specificity refers to | proportion of people WITHOUT AF that have a NEGATIVE TEST |
| symptoms of AF | Breathlessness Palpitations (awareness of your own heart beat) Chest discomfort Syncope (fainting) or dizziness Reduced exercise tolerance, malaise/listlessness None (25-30%) |
| stroke and thromboembolism prevention | anti-coagulation |
| AF can cause what | thromboembolic stroke |
| what is the CHA₂DS₂-VASc criteria/ risk assessment | used to calculate patient's stroke risk |
| CHA₂DS₂-VASc criteria/ risk assessment includes | congestive heart failure/ left ventricular dysfunction hypertension age 75yrs+ diabetes mellitus stroke/ TIA vascular disease prior to MI age 65-74yrs sex (female) |
| according to CHA₂DS₂-VASc criteria/ risk assessment when should you offer anticoagulation | score of 2 or above (taking bleeding risk into account) |
| what should be considered for men with a CHA₂DS₂-VASc score of 1 | anticoagulation (take bleeding risk into account) |
| who should NOT have stroke prevention therapy | those aged under 65 years with AF and no risk factors other than their sex (CHA₂DS₂-VASc score of 0 for men and 1 for women) |
| ORBIT risk assessment checks | bleeding risk (outcomes registry for better informed treatment of AF) Older (75yrs+) (1) reduced haemoglobin (2) bleeding history (2) insufficient kidney function (1) treatment with an antiplatelet agent (1) low risk = 0-2 medium = 3 high = 4+ |
| according to ORBIT bleeding risk score- offer modification and monitoring of following risk factors | uncontrolled hypertension poor control of INR concurrent medication eg aspirin/ NSAID harmful alcohol consumption |
| non vitamin K antagonist oral anticoagulant (NOACs) for stroke prevention in non valvular AF (4) | alternatives to warfarin including apixaban dabigatran etexilate edoxaban tosylate rivaroxaban |
| how do NOACs work | selectively target specific factors in coagulation cascade |
| dabigatran etexilate targets | thrombin |
| apixaban, edoxaban tosylate and rivaroxaban targets | factor Xa |
| which drugs can warfarin not be used with (drug interactions) (4) | Clopidogrel NSAIDs LMWH SSRI antidepressants |
| which foods and drinks can warfarin not be used with (drug interactions) | heavy alcohol consumption vitamin K rich foods (liver, broccoli, brussels sprouts) |
| therapeutic options for thromboembolism prevention | warfarin or NOACs |
| medication to control AF rhythm (4) | Bet blockers, sotalol, flecainide, amiodarone |
| rhythm control of AF includes (4) | medication DC cardioversion (using shock to reset heart rhythm) catheter ablation therapy using radio-frequency of cryoablation (use heat or cold to destroy faulty parts) surgical MAZE procedure (surgery to block bad signals) |
| other important things to advice the patient | it is their responsibility to inform the DVLA of any condition that may affect their ability to drive and flying has no restrictions PROVIDED AF is stable and has not recently worsened/ become more symptomatic |
Created by:
kablooey
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