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af
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AFNormal sinus Rhythm
Atrial FibrillationFast Irregularly Irregular
SymptomsPalpitationBreathlessnessSignsFast irregular pulse
Assess effect Cardiac FailureBlood pressure
ClassificationIs it Episodic?
Yes
ParoxysmalNo
?Chronic
Paroxysmal If reverts to sinus rhythm within 7 days
Paroxysmal -No PersistentReverts to sinus with treatment
Persistent AF no Permanent Reverting failure
Proximal permanent
TreatmentAnticoagulation CHAD S2 ScoreCCF -1HYpertention -1Age over 75 -1Diabetes Mellitus -1Stroke or TIA -2
Anticoagulation CHAD S2 0-1 AspirinCHAD S2 2-3 Aspirin /WarfarineCHAD S2 3 or above Warfarine
Target INR 2-3
Valvular Heart Disease anticoagulation Warfarine (No CHAD S2 )
Alone AF -No anticoagulation
Rate control in acute AFBeta Blocker- IV Atenolol 5 mg over 5 min
Calcium Channel Blocker-Verapamil 5- 10 mg over 5 min
Digoxin IV loading dose 1 mg over 2h Amiodarone
Rate Control In Chronic AFDrug of choice - Beta Blocker or Calcium Channel Blocker (Atenolol,Verapamil,Ditiazem, Digoxin)
Rhythm control Cardio version Drugs
CardioversionECG Evidence of Acute MIHypotensionHemodynamic InstabilityWPW SyndromeDrugsTry if less than 24 or 48 hoursAmiodarone,Propranolol avoid in Ashma
Flecainide (Avoid in Coronary Heart disease)
Maintain Sinus Rhythm with Atenolol, Sotalol,Amiodarone
AF in HyperthyroidismDefinitionThyroid over activityCausesGraves diseaseToxic Multinodular GoitreSolitary Toxic Nodule/Adenoma
TreatmentAnti Thyroid Drugs E.g. Carbimazole,PropylthiouracilThyroidectomyRadioactive Iodine
HypothyroidismPrimary
Secondary
Confirm TSH & T4
Treatment Life Long Thyroxine on empty stomach
MonitorTSH & T4
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