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