AF

Normal sinus Rhythm

Atrial Fibrillation
Fast Irregularly Irregular Symptoms Palpitation Breathlessness Signs Fast irregular pulse

 Assess effect Cardiac Failure Blood pressure

Classification
Is it Episodic?

Yes

No

Paroxysmal

?Chronic

Paroxysmal

If reverts to sinus rhythm within 7 days

Reverts to sinus with treatment

Reverting failure

Paroxysmal No Persistent

Persistent AF no Permanent

Proximal permanent

 Treatment Anticoagulation CHAD S2 Score

CCF HYpertention Age over 75 Diabetes Mellitus Stroke or TIA -1 -1 -1 -1 -2

 Anticoagulation CHAD S2 CHAD S2 CHAD S2

0-1 Aspirin 2-3 Aspirin /Warfarine 3 or above Warfarine

Target INR 2-3

 Valvular Heart Disease anticoagulation Warfarine (No CHAD S2 )

Alone AF -No anticoagulation

Rate control in acute AF

Beta 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 AF

Drug of choice - Beta Blocker or Calcium Channel Blocker (Atenolol,Verapamil,Ditiazem, Digoxin)

Rhythm control

Cardio version

Drugs

 Cardioversion ECG Evidence of Acute MI Hypotension Hemodynamic Instability WPW Syndrome Drugs Try if less than 24 or 48 hours Amiodarone,Propranolol avoid in Ashma

 Flecainide (Avoid in Coronary Heart disease) Maintain Sinus Rhythm with Atenolol, Sotalol, Amiodarone

AF in Hyperthyroidism
Definition Thyroid over activity Causes Graves disease Toxic Multinodular Goitre Solitary Toxic Nodule/Adenoma

 Treatment Anti Thyroid Drugs E.g. Carbimazole,Propylthiouracil Thyroidectomy Radioactive Iodine

Hypothyroidism

Primary

Secondary

 Confirm
TSH & T4 Treatment Life Long Thyroxine on empty stomach Monitor TSH & T4