AFNormal sinus Rhythm

Atrial FibrillationFast Irregularly Irregular

SymptomsPalpitationBreathlessnessSignsFast irregular pulse

Assess effect Cardiac FailureBlood pressure

ClassificationIs it Episodic?

Yes

ParoxysmalNo

?Chronic

Paroxysmal If reverts to sinus rhythm within 7 days

Paroxysmal -No PersistentReverts to sinus with treatment

Persistent AF no Permanent Reverting failure

Proximal permanent

TreatmentAnticoagulation CHAD S2 ScoreCCF -1HYpertention -1Age over 75 -1Diabetes Mellitus -1Stroke or TIA -2

Anticoagulation CHAD S2 0-1 AspirinCHAD S2 2-3 Aspirin /WarfarineCHAD S2 3 or above Warfarine

Target INR 2-3

Valvular Heart Disease anticoagulation Warfarine (No CHAD S2 )

Alone AF -No anticoagulation

Rate control in acute AFBeta 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 AFDrug of choice - Beta Blocker or Calcium Channel Blocker (Atenolol,Verapamil,Ditiazem, Digoxin)

Rhythm control Cardio version Drugs

CardioversionECG Evidence of Acute MIHypotensionHemodynamic InstabilityWPW SyndromeDrugsTry if less than 24 or 48 hoursAmiodarone,Propranolol avoid in Ashma

Flecainide (Avoid in Coronary Heart disease)

Maintain Sinus Rhythm with Atenolol, Sotalol,Amiodarone

AF in HyperthyroidismDefinitionThyroid over activityCausesGraves diseaseToxic Multinodular GoitreSolitary Toxic Nodule/Adenoma

TreatmentAnti Thyroid Drugs E.g. Carbimazole,PropylthiouracilThyroidectomyRadioactive Iodine

HypothyroidismPrimary

Secondary

Confirm TSH & T4

Treatment Life Long Thyroxine on empty stomach

MonitorTSH & T4

***