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Pathology
Atria contract at 400-600bpm, ventricular rate determined by AV node conduction.
It is classified as
Paroxysmal: terminates spontaneously and lasts less than 7 days
Persistent: lasts more than 7 days and is terminated by treatment
Permanent: cannot restore sinus rhythm.Aetiology
Structural or Valvular heart disease (mainly mitral stenosis)
Ischaemic heart disease/Hypertension/Congestive Heart Failure
Excessive alcohol consumption (>3drinks/day)
Pulmonary diseases (COPD/PE)
Post Cardiothoracic surgery
Hyperthyroidism
Signs
Irregularly, irregular pulse which can be slow, fast or normal.
Symptoms
Irregular fast palpitations, SOB, dizziness and decreased exercise tolerance
Investigations
Bloods: FBC, TFTs
ECG: No visible P waves and irregularly irregular QRS complexes
24 Hour ECG: Holter monitor
Echo: Assess for structural abnormality
Treatment
Rate or rhythm control and anticoagulation
Rate control: Beta blockers, calcium blockers, digoxin or a combination
Rhythm control: Pharmacological or electrical (DCCV)
IV amiodarone used for acute onset AF
Antithrombotic: Assess risk with CHADS2 or CHA2DS2-VASc score
Ablation: Cox-Maze Procedure
Prognosis
Stroke, TIA, impaired exercise capacity, heart failure and dementia
AF is associated with an increase in mortality
Key Facts
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Key References
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