Atrial Fibrillation

DEFINITION
Atrium beat rapidly and ineffectively with ventricles responding at irregular intervals.

SIGNS & SYMPTOMS •

AETIOLOGY
Hypertension
• Irregularly irregular pulse • Chest pain • Coronary heart disease
• Palpitations • Syncope • Cardiac surgery
• High blood pressure • Asymptomatic • Rheumatic heart disease
• Pulmonary embolism
• Dyspnoea
• Pneumonia
Thyrotoxicosis
INVESTIGATIONS •
• Sepsis
• EtOH misuse
• Irregularly irregular • Urea & electrolytes • LA enlargement
rhythm • Caffeine
• Troponin I/T & creatinine • Mitral valve disease
• Absent P waves phosphokinase (rule I/O • Poor LV funciton
• Fibrillating f waves MI) CLASSIFICATIONS
• Structural abnormalities
(inconsistent baseline) • Thyroid function (T3 & Lone
• Irregular QRS complexes THS)
•Patients < 60 y/o
•No underlying cause found
ECG Bloods Echo Paroxysmal
•Episodes terminate
spontaneously
CHA2DS2-VASc SCORE: Persistent
Score indicating risk of stroke & need for anticoagulation in AFib and Aflutter. •Sustained > 7 days
•Terminates with only
CHF 1 Vascular disease 1 cardioversion
HTN 1 Age 1 Chronic
Age > 75 2 Sex (female) 1 •Long term AFib
DM 1 Score = 0: low risk; no anticoagulation •Unresponsive to
Stroke/thromboembolism 2 Score = 1: low/mod; consider cardioversion and
Score ≥ 2: mod-high risk; anticoagulate medications
Recurrent
•Two or more episodes
MANAGEMENT
Secondary

Rate control Anticoagulation Cardioversion Etiology •Caused by underlying event

(hyperthyroid, MI, ect.)
No CHF or HTN AFib < 24 hours
NOAC HAS-BLED SCORE:
• Calcium channel • Cardioversion, no
blockers (apixaban, anticoagulation Estimates risk of bleeding for
(lircandipine) rivaroxaban) Treat patients on anticoagulants.
underlying
• Beta blockers
AFib > 24 hours cause, if Hypertension 1
(bisoprolol)
1) Anticoagulation present. Abnormal LFT/RFT 1 each
Warfarin 3/52 Stroke 1
CHF or HTN
(INR 2.0-3.0)
2) Cardioversion Bleeding tendency 1
• Digoxin 3) Anticoagulation
• Amiodarone 4/52 Labile (high) INR 1
Elderly (>65) 1
Drugs or alcohol 1 each
Score ≤ 2: low bleed risk
Score > 3: high bleed risk