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afya
AtrialFibrillation
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> risk of embolic stroke inc 5x with AF M>F 1.5x Paroxysmal AF - terminates within 7 days usually within 48hrs Persistent AF - not self terminating, lasting >7days Permanent AF - long standing (>1yr), that doesn't stay reverted unless eg ablation done 1% population (18% of over 85's) M>F Lone, HT, cardiac disease, respiratory disease, genetics, hyperthyroid, alcohol / caffeine, infection, sarcoid aSx, palpitations, heart failure, syncope, ''Ix'' - ECG (?24hr tape), echo/CXR/TFT FBC U/E LFT ''Mx'' control rate or rhythm thromboprophylaxis - stroke risk treat underlying cause - infection, thyroid treat heart failure stop smoking, less alcohol and caffeine ''Rate control'' >65yrs, persistent, cardiac disease (so unlikely to revert) aim for ventricular rate of <80 and 90-110 with exertion rate limiting ''CCB'' (Verapamil or Diltiazem NOT Amlodipine) or ''BB'' (doesn't have to be cardio-selective but ?better) (not with verapamil) ''Digoxin'' - OK if sedentary but not inc with exercize - useful as 2nd drug or in heart failure ''Rhythm control'' (2ndary care) better if paroxysmal, cause treated, younger, Sx, no structural disease, heart failure, 2ndary to corrected precipitant (eg alcohol) cardioversion - 80% success, needs full anticoagulation - 3/52 before and 4/52 after unless AF<48hrs ''flecainide or sotalol''- if no structural abN ''amiodarone'' - OK if structural abN, helps maintain SR, lots SE electrical - as emergency if haemodynamically unstable - electrical or IV amiodarone Thromboprophylaxis aspirin alone is not enough warfarin or rivaroxaban (or dabigatran) reduces risk of stroke by 70%
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Cardiovascular