Download Atrial fibrillation

Atrial fibrillation
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Cardiology #2
Gimadeeva A.D.
Atrial fibrillation
• Cardaic arrhythmia that involves the two
upper chambers (atrias) of the heart beat
irregularly or quiver
• 1 in 25 people aged 60 and older
• 10% of people over 80 having AF
• 15-20% of all strokes
Classification
• Paroxysmal-first detected episode selfterrminates in less than 7 days
• Persistent-episodes lasts for more than 7
days
• Permanent-episode is ongoing for a long
time
Signs & Symptoms
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Palpitation
Exersize intolerance
Angina
Shortness of breath, edema
ECG
Echocardiography
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Identify valvular heart disease
Left &right atria size
Left ventricular size & function
Peak right ventricular pressure
Presense of left ventricular hypertrophy
Pericardial disease
Transesophageal
echocardiography
• Prefer when planning urgent electrical
cardioversion for identifying thrombi &
sluggish bloodflow
• Best visualisation of appandageplace,where thrombus most commonly is
formed
Etiology
• High blood pressure
• Heart disease-coronary artery disease,mitral
stenosis,mitral regurgitation, hypertrophic
cardiomyopathy, pericarditis, heart
surgery,congenital heart disease
• Lung disease
• Holiday heart syndrom
• Hyperthyroidism
• Carbon monoxide poisoning
• Dual-chamber pacemakers in the presense of
normal AV-conduction
Goals of treatment
To restore regular heart ratemedications,cardioversion,RFA
To control the heart rate- digoxin,BB
To prevent blood clots forming & causing
strokes-Warfarin, Pradaxa, closure
Watchman
Anticoagulation therapy
• Risk of thromboembolic events
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CHADS2 score (2001)
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CHA2DS2-VAS score (European
guidelines)
• Risk of bleeding
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HAS-BLED score (2010)
For patients with CHA2DS2-VAS
score of 2 or greater & HAS-BLED
score of <3 anticoagulation
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CHA2DS2-VAS
CHF or EF<35%
AGE>75 -2p
DM
Prior TIA,CVA or emboli
Vascular-prior PVD or MI
Age 65-75-1 p
Sex-female 1p
• HAS-Bled score
• Hypertension>160mmhg
• Abnormal kidney or liver
function
• Stroke
• Bleeding history
• Labile INR(in
range<60%)
• Elderly >65
• Drugs(ASA,Plavix),>8
drink/week
• Pradaxa ,Dabigratan
• Direct thrombin
inhibitors
• 110mg 2x
• 150 mg 2x
• Warfarin
• INR 2-3
Thanks for attention