In people with A-fib, the electrical signals that control the heartbeat become abnormal. As a result, the top 2 chambers of the heart stop pumping effectively, and a small amount of the blood that should move out of these chambers gets left behind. As the blood pools, it can start to form clots. These clots can travel to the brain through the blood vessels, and cause strokes.
CVA risk is greater with PHX CVA , valvular disease , prosthetic mitral valve , and cardiac failure
Paroxysmal <48hours persistent >7d permanent chronic cannot convert to normal rhythm . all type similar risk for stroke .
AF is the Main source of cardioembolic infraction.
Investigations – EUC,LFT , TFT, Digoxin ,echo , consider Holter , TE echo, sleep sonography
1 Aim – control rate rhythm and anticoagulation to reduce risk of stroke
2 valvular AF INR target 2-3 with warfarin
non-valvular assess risk benefit. Stroke risk CHADS2VAS and HASBLED—– anticoagulant
In patients with nonvalvular AFib and a CHA2DS2VASc score of 0 in men or 1 in women, anticoagulant therapy may be omitted.
In patients with nonvalvular AFib and a CHA2DS2VASc score ≥1 oral anticoagulant therapy may be considered. Aspirin is no longer recommended for antithrombotic therapy in atrial fibrillation.
Warfarin for valvular
Warfarin or NOAC Dabigatran (Pradaxa), apixaban (Eliquis), rivaroxaban (Xarelto) in nonvalvular
Renal and hepatic functions should be evaluated prior to initiation of direct thrombin or factor Xa inhibitors
- Treat Risk factors – MI, thyrotoxicosis , hypertension, pericarditis ,cardiomyopathy including chronic alcohol dependence , OSA, drugs, PE , obesity
4 Controlling BP,
5.minimise alcohol and caffein,
- stop smoking
- regular exercise – SNAPS C salt – if patient on wafarine stable green leaf and advice on bleeding tendency –
- Bleeding and stroke red flags
- Treat causes comorbidities and precipitating factors
- 4 R
Restoration of sinus rhythm using electrical or pharmacologic cardioversion may significantly reduce the symptom burden of AFib or AFlut in many patients and may also be useful for controlling ventricular rate. Cardioversion does not impact the long-term risk/benefit ratio of anticoagulation:
Urgent cardioversion needs for patient hemodynamically unstable
INR monitoring for patient on warfarin and LFT and RFT monitoring in patient with NOAC