{"id":823,"date":"2017-05-22T06:28:07","date_gmt":"2017-05-22T06:28:31","guid":{"rendered":"http:\/\/papergp.com\/index.php\/cardiovascular\/af\/"},"modified":"2023-01-24T11:25:25","modified_gmt":"2023-01-24T11:25:25","slug":"af","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/cardiovascular\/af\/","title":{"rendered":"Atrial Fibrillation"},"content":{"rendered":"<div class=\"content-box-blue\">\n<h4><strong>Data gathering<\/strong><\/h4>\n<ul>\n<li>Red flags\n<ul>\n<li>Loss of consciousness<\/li>\n<li>Lightheaded<\/li>\n<li>Chest pain<\/li>\n<li>Significant breathlessness<\/li>\n<li>Haemodynamic instability<\/li>\n<\/ul>\n<\/li>\n<li>Examine\n<ul>\n<li>Pulse, BP, sats<\/li>\n<li>CV<\/li>\n<li>CCF signs<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<div class=\"content-box-blue\">\n<h4><strong>Clinical management<\/strong><\/h4>\n<ul>\n<li>Investigations\n<ul>\n<li>Bloods &#8211; FBC, U+E, LFTs, TFTs, Ca, Mg, HbA1c, lipids<\/li>\n<li>ECG<\/li>\n<li>Echo (after rate controlled)<\/li>\n<\/ul>\n<\/li>\n<li>Explanation<\/li>\n<li>Treatment\n<ul>\n<li>Rate control\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Bisoprolol 1.25mg titrated upwards to max 10mg\n<ul>\n<li>Aim rate 60-80bpm<\/li>\n<li>Follow-up after 1 week\n<ul>\n<li>Poor rate control with single agent\n<ul>\n<li>Add diltiazem +- digoxin<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Digoxin monotherapy\n<ul>\n<li>non-paroxysmal AF and sedentary patient<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Rhythm control\n<ul>\n<li>See below<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<ul>\n<li>Anticoagulation\n<ul>\n<li>Refer to <a href=\"http:\/\/gp.barnetccg.nhs.uk\/downloads\/services\/pathways\/Cardio\/NHS-Barnet-CCG-LCS-Oral-anticoagulation-protocol-May-2017-v3.pdf\">anticoagulation<\/a> team\n<ul>\n<li>\u00a0CHA2DS2-VASc \u2265 1 for men + HAS-BLED\u00a0\u2264 2<\/li>\n<li>\u00a0CHA2DS2-VASc \u2265 2 for women + HAS-BLED\u00a0\u2264 2<\/li>\n<\/ul>\n<\/li>\n<li>HAS-BLED &gt; 3, consider referral to cardiology<\/li>\n<\/ul>\n<\/li>\n<li>Followup \/ Safety-net\n<ul>\n<li>Urgent referral if red flags<\/li>\n<li>Onset of symptoms less than 48 hours<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<div class=\"content-box-blue\">\n<h4><strong>Rhythm Control<\/strong><\/h4>\n<ul>\n<li>Discuss with on-call cardiologist for consideration of cardioversion if\n<ul>\n<li>onset of symptoms &lt;48 hours<\/li>\n<li>symptomatic<\/li>\n<li>&lt; 75 years old (or by discretion)<\/li>\n<li>first presentation with lone AF<\/li>\n<li>secondary to treated trigger<\/li>\n<li>congestive heart failure<\/li>\n<li>suitable for AF ablation<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<div class=\"content-box-blue\">\n<h4><strong>Exclude underlying causes or triggers<\/strong><\/h4>\n<ul>\n<li>Cardiac\n<ul>\n<li>Hypertension<\/li>\n<li>Valvular heart disease<\/li>\n<li>Heart failure<\/li>\n<li>IHD<\/li>\n<\/ul>\n<\/li>\n<li>Respiratory\n<ul>\n<li>Chest infections<\/li>\n<li>PE<\/li>\n<li>Lung Ca<\/li>\n<\/ul>\n<\/li>\n<li>Systemic\n<ul>\n<li>Alcohol excess<\/li>\n<li>Thyrotoxicosis<\/li>\n<li>Electrolyte depletion<\/li>\n<li>Infections<\/li>\n<li>Diabetes<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<div class=\"content-box-blue\">\n<h4><strong>Reference<\/strong><\/h4>\n<p><a href=\"https:\/\/gps.camdenccg.nhs.uk\/cdn\/serve\/pathway-downloads\/1513934129-896d7baf2c07f8f4480a5f96d23b8086.pdf\">Camden CCG Atrial Fibrillation Pathway<\/a><\/p>\n<p><a href=\"http:\/\/gp.barnetccg.nhs.uk\/downloads\/services\/pathways\/Cardio\/NHS-Barnet-CCG-LCS-Oral-anticoagulation-protocol-May-2017-v3.pdf\">http:\/\/gp.barnetccg.nhs.uk\/downloads\/services\/pathways\/Cardio\/NHS-Barnet-CCG-LCS-Oral-anticoagulation-protocol-May-2017-v3.pdf<\/a><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Data gathering Red flags Loss of consciousness Lightheaded Chest pain Significant breathlessness Haemodynamic instability Examine Pulse, BP, sats CV CCF signs Clinical management Investigations Bloods &#8211; FBC, U+E, LFTs, TFTs, Ca, Mg, HbA1c, lipids ECG Echo (after rate controlled) Explanation Treatment Rate control Bisoprolol 1.25mg titrated upwards to max 10mg Aim rate 60-80bpm Follow-up after &hellip; <a href=\"https:\/\/papergp.com\/index.php\/cardiovascular\/af\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">Atrial Fibrillation<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":284,"menu_order":50,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-823","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/823","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=823"}],"version-history":[{"count":8,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/823\/revisions"}],"predecessor-version":[{"id":2392,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/823\/revisions\/2392"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/284"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=823"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}