Flashcards in AF Deck (16):
SV tachyarrhythmia. disorganised rapid atrial activation and uncoordinated atrial contraction.
structural or electrophysiological abnormality promotes abnormal impulse formation or propagation. Normal regular SAN impulses overwhelmed by disorganised impulses usually originating in PV roots. Irregular ventricular conduction.
Paroxysmal- more than one episode terminate spontaneously or with intervention in 7 days.
Persistent- episodes last over 7 days.
Long standing persistent- for over 1 year. Cardioversion failed or not tried.
Permanent- stop pursuing SR.
Loss atrial muscle mass and atrial fibrosis.
Re entrant and focal mechanisms cause multiple wandering waves usually originating from PVs.
Cardiomyopathy, CHF, HTN (most common)
Peri and myocarditis.
Atrial tachy and flutter, WPW.
HypoK and Mg.
Lung- PE, COPD, apnoea, CO, CA
Exercise of alcohol can trigger
Multifocal atrial tachy, Flutter, WPW, MI
Irregularly irregular pulse
Apical pulse rate greater than radial
1st heart sound variable intensity
Heparin acute, warfarin long term (inhibits vit K reductase preventing CF activation in liver).
Rate control- BB eg atenolol, CCB eg varapimil, digoxin.
Rhythm control- amiodarone, flecainide.
Stroke due to turbulence= clot, to brain.
Echocardiogram for cause
Bloods- UE, cardiac enzymes, TFTs.
Class 2 BB
Inhibit heart beta 1 Rs. Less Ca IN.
Slow ventricular rate in AF and flutter.
AE- bronchospasm, hypotension.
DONT use in partial AV block or acute V failure unless pm in situ.
Class 3 K blocker eg amiodarone.
Lot AE- proarrhythmic, pulmonary fibrosis, hepatic injury, increase LDL, thyroid disease, photosensitivity, optic neuritis.
Require high loading dose as long t1/2.
Give to central V to avoid thrombophlebitis.
DDI- digoxin, class 1's, warfarin.
Class 1c eg flecainide
VGNa blocker, use dependant. Slower binding offset than other class 1's.
AE- pro arrhythmic, sudden death chronic use, CNS, GI, metallic taste, headache. Increase ventricular response to SV arrhythmia.
Class 1a eg quinidine, procainamide.
Intermediate binding offset.
AE- hypotension, low CO, torsades increase QT. Dizzy, confusion, insomnia, seizure. GI. Lupus like syndrome.
Class 4 CCB eg verapimil, diltiazem
Decrease force and rate, some peripheral vasodilation.
Diltiazem for AF
Caution if partial AV block AND on BB- can=asystole.
Caution in hypotension as reduce CO.
Adenosine no class
Activates K current in nodes. Blocks conduction then restarts SR.
V short t1/2 (seconds)
Cardiac glycoside eg digoxin
Blocks Na/K ATPase, reverses NCX, more Ca IN.
Also increases vagal activity (increase K current, decrease Ca=slows AV conduction and HR).