Atrial Fibrillation

Causes

Systemic

  • Hypoglycemia

  • Theophylline intoxication

  • Pneumonia

  • Acute asthma

  • Pulmonary embolus

  • COPD

  • Alcohol use

  • Alcohol withdrawal

  • Hyperthyroidism

Cardiac Disease

  • Left or right ventricular failure

  • Mitral valve disease (stenosis or regurgitation)

  • Pericarditis

  • LVH, hypertensive heart disease

  • Hypertrophic cardiomyopathy

  • Coronary artery disease

  • Atrial septal defect

  • Aortic stenosis

  • Infiltrative diseases (amyloidosis, cardiac tumor)

  • Post cardiac surgery

  • Acute myocardial infarction

No Underlying Disease

  • Lone atrial fibrillation

  • Paroxysmal atrial fibrillation

  • Sick sinus syndrome

Medication Management

"CHAD2" Score Risk Assessment

Traditional

1 Point each for:
    CHF or EF<35%
    HTN
    Age over 75
    Diabetes
2 Points for Hx CVA or TIA

Risk of Stroke Interpretation
    Score 0= Low risk                      Suggest Aspirin
    Score 1-2= Intermediate risk    Suggest Aspirin or Warfarin
    Score >2 = High risk                 Suggest Warfarin

Newer Score CHA2DS2-VAsc Index

1 Point each for non-major risk factors (each considered a non-definitive risk factor):
    CHF or recent heart failure
    Age 65-75
    HTN
    Diabetes
    Vascular Disease ( MI, complex aortic plaque, PAD, prior revascularization, amputation because of PAD, or                            angiographic evidence of PAD)
    Female gender

2 Point each for major risk factors(definitive risk factors):
    Hx of stroke or transient ischemic attack
    Age over 75

Risk of Stroke Interpretation
    Score 0= Low risk                  Suggest Aspirin or nothing at all (0% risk thromboembolism in first year)
    Score 1= Intermediate risk    Suggest Warfarin over Aspirin (0.6% in the first year)
    Score 2 and above= High risk    Suggest Warfarin strongly
     
 

Anticoagulation

Warfarin:  for all patients at increased risk, unless contraindicated or at low risk as above

Rate Control

Beta Blockers

  • Atenolol

  • Metoprolol


Calcium Channel Blockers

  • Diltiazem

  • Verapimil


Digitalis Preparations

  • Digoxin

  • Digitoxin

Acute Conversion

Cardioversion

Drugs

  • Amiodarone

  • Dofetilide

  • Flecainide

  • Ibutilide

  • Propafenone

  • Quinidine

Maintenance of Sinus Rhythm

Drugs

  • Amiodarone

  • Disopyramide

  • Propafenone

  • Sotalol

 

 

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