Heart Failure- inability of CO --> physiologic demands
Atrial Fibrillation- chaotic, irregular atrial rhythm at 300-600bpm
uncoordinated atrial activity on surface ECG - temporal, paroxysmal, persistent, permanent
Heart Failure- inability of CO --> physiologic demands
Atrial Fibrillation- chaotic, irregular atrial rhythm at 300-600bpm
uncoordinated atrial activity on surface ECG - temporal, paroxysmal, persistent, permanent
Epi
Signs/Symptoms
Left
Right
Aetiology/Pathophysiology
Causes:
IHD, cardiomyopahty, hypertension, valvular HD- mitral/aortic/tricuspid
Systolic - inadequate myocardial contractile function - consequence of IHD/hypertension
Diastolic dysfunction - inability of heart to adequately relax and fill - massive left ventricular hypertrophy, myocardial fibrosis, amyloid deposition, contrictive pericarditis
Pathophysiology - compensate for reduced myocardial contractility:
Frank-Starling
Activation of neurohumoral systems:
Myocardial structural changes:
Diagnosis
if BNP >400 - refer immediately
Management
Acute
Chronic
lifestyle - exercise, smoking, alcohol, sexual activity, vaccination (influenza, pneumococcal disease), air travel, driving
ACEi + beta blockers
All types:
Epi/Risk factors
0.5-1% , increasing age,
HTN, CAD, CHF, age, DM
rheumatic valvular --> mitral stenosis
alcohol --> cardiomyopathy
arrhythmias --> reentrance
smoking
thyroid
Aetiology
HF, HTN, valve disease - mitral stenosis, regurg, hyperthyroidism, alcohol induced, familial, electrolytes
Signs/Symptoms
incidental/none, chest pain, palpitations, dyspnea, faintness, stroke/TIA, syncope/dizzyness
Signs- irregularly irregular pulse, apical pulse rate > radial, 1st HS- variable
Pathogenesis- pul veins --> dysfunction of cardiac electrical signalling, atria no longer in contract in coordinated manner, atria fall to empty adequately (no longer coordinated contraction)
Diagnosis
ECG- P waves - absent, irregular QRS complex (RR intervals), narrow QRS
Blood - U/E - cardiac enzymes, thyroid function, echo --> atrial enlargement/ mitral valve disease
Management
Thromboprophylaxis
Assessment of stroke: CHA2DS2VASc - age, sex, CHF, HTN, stroke hx, vascular disease hx, DM hx
Assessment for major bleeding risk - HAS BLED - HTN, Renal disease , Liver disease, stroke, prior major bleeding or predisposition to bleeding, age >65, medication (antiPLT/NSAIDs), alcohol or drug use > 8 drinks
Anticoagulation (men with score >1, people >1)
Apixaban (AF + 1 risk factor - stroke/TIA, >75, HTN, DM, HF)
Rivaroxaban - AF + 1 RF (CHF, HTN, >75, DM)
Vit K antagonists - calcular TTR
Rate and Rhythm Control
Rate (give as 1st line except when reversible, HF caused by AF, new onset AF, atrial flutter)
Digoxin - monotherapy with non paroxysmal AF + sedentary
Combination therapy (2 of)
Rhythm - pharm/electrical- AF whose symptoms continue after HR controlled or rate control not successful
Long term
Drondedarone (sinus rhythm after cardioversion in paroxysmal or persistent AF)