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Atrial Fibrillation - Coggle Diagram
Atrial Fibrillation
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Review
Annually once symptoms controlled/drug treatment/doses established, more frequently if required
Check for symptoms at rest, during exercise, and assess heart rate
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Manage modifiable risk factors eg uncontrolled hypertension, use of aspirin/nsaids, harmful alcohol consumption.
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Diagnosis:
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Paroxysmal AF and AF not detected on standard ECG, arrange ambulatory ECG.
Management
Onset AF within 48 hours
Admit urgently to AMU for emergency electrical cardioversion if the person is showing signs/symptoms of haemodynamic instability eg rapid pulse (>150 bpm), and/or low BP (systolic < 90mmHg), loss of consciousness, severe dizziness or syncope, ongoing chest pain or increasing breathlessness
No signs of haemodynamic instability- consider management in Primary care or refer to AMU for immediate cardioversion dependent on clinical judgement and person's preference.
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Risk Assessment:
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Discuss results with the individual looking at co-morbidities, individual preference and benefits/risk of medication.
Medication
Anticoagulation
Offer direct-acting anticoagulant (DOAC) to those AF and CHA2DS2VASc Score of 2 or above, consider for men with score of 1, taking into consideration bleeding risk.
Apixaban, dabigatran, edoxaban, rivaroxaban
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For those not suitable for DOAC, offer Vitamin K antagonist.
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Rate control
First line treatment - either standard beta-blocker or rate limiting calcium-channel blocker (diltiazem or verapamil) - choice based on HR, comorbidities and preference
Digoxin possible alternative with non-paroxysmal AF and little/no exercise and other rate control rules out due to co-morbidities/perference
Follow up within 1 week to review tolerance, symptoms control, heart rate and blood pressure.
Provide information
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Driving - Responsibility of person to inform DVLA of any condition which may affect their ability to drive
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Classifications
Permanent AF
AF that fails to terminate using cardioversion, AF that is terminated but relapses within 24 hours, or longstanding AF (usually longer than 1 year) in which cardioversion has not been indicated or attempted (sometimes called accepted permanent AF).
Paroxysmal AF
episodes lasting longer than 30 seconds but less than 7 days (often less than 48 hours) that are self-terminating and recurrent.
Persistent AF
episodes lasting longer than 7 days (spontaneous termination of the arrhythmia is unlikely to occur after this time) or less than seven days but requiring pharmacological or electrical cardioversion.
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Atrial fibrillation (AF) is a supraventricular tachyarrhythmia resulting from irregular, disorganized electrical activity and ineffective contraction of the atria.