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Atrial fibrillation • • 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 • • • • Palpitation Exersize intolerance Angina Shortness of breath, edema ECG Echocardiography • • • • • • 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 • CHADS2 score (2001) • CHA2DS2-VAS score (European guidelines) • Risk of bleeding • HAS-BLED score (2010) For patients with CHA2DS2-VAS score of 2 or greater & HAS-BLED score of <3 anticoagulation • • • • • • • • 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
