Atrial Fibrillation
Ventricular fibrillation is chaotic and irregular, and atrial fibrillation is irregular with narrow QRS complexes.
Treatment at a glance
- Rate control: bisoprolol or diltiazem
- Anticoagulate by CHA₂DS₂-VASc score: a DOAC (rivaroxaban) in non-valvular AF
What our notes say
- Ventricular fibrillation is chaotic and irregular, and atrial fibrillation is irregular with narrow QRS complexes. (Paediatrics end of second semester exam (MBPE 4300): 4 October 2022, cardiology,)
- Aspirin alone is not recommended for stroke prevention in atrial fibrillation. (Cardiology Question Bank: 15 Clinical MCQs)
- A 74-year-old woman, fatigue, irregular pulse 120, atrial fibrillation, EF 20% with global hypokinesis (earlier 40%), on lisinopril, metoprolol XL and aspirin (Clinical Pharmacology I (MBPL 4400) main exam: 25 January 2023)
- ECG (atrial fibrillation), full blood count, urea, electrolytes, creatinine, lipids, clotting profile, ESR, HIV and syphilis serology where relevant, and troponin. (Internal Medicine (MBIM 4100) main exam, Paper One: 3 July 2019)
- Secondary prevention: antiplatelet (aspirin plus clopidogrel briefly), statin, blood pressure control, treat atrial fibrillation with anticoagulation, stop smoking, and diabetes control. (Internal Medicine (MBIM 4100) main exam, Paper One: 3 July 2019)
- The left atrium enlarges and fibrillates, and stasis leads to thrombus and systemic emboli, so these patients need anticoagulation (warfarin in rheumatic mitral stenosis with atrial fibrillation). (Cardiology Question Bank: 15 Clinical MCQs)
Study material on Atrial Fibrillation
- Cardiovascular system examination revised 2012
- Cardiology Question Bank: 15 Clinical MCQs
- 🫀 VALVULAR HEART DISEASE — ULTRA DEEP NOTES
- Paediatrics end of second semester exam (MBPE 4300): 4 October 2022, cardiology, hepatology and gastroenterology, 47 of 50 MCQs
- Heart failure: which tests and why
Practice questions on Atrial Fibrillation
A 49-year-old woman with poorly controlled atrial fibrillation dies after a stroke. Autopsy shows fused mitral leaflets, shortened chordae, and thrombus-filled enlarged left atrium. What is the most likely underlying cause?
- Rheumatic heart disease
- Hypertrophic cardiomyopathy
- Dilated cardiomyopathy
- Infective endocarditis
Answer: A. The findings of fused mitral leaflets, shortened chordae, left atrial enlargement, and thrombus formation are highly characteristic of chronic rheumatic heart disease, a sequela of rheumatic fever, which predisposes to atrial fibrillation and thromboembolic events.
A 49-year-old woman with poorly controlled atrial fibrillation dies after a stroke. Autopsy shows fused mitral leaflets, shortened chordae, and thrombus-filled enlarged left atrium. Most likely underlying cause?
- Rheumatic heart disease
- Degenerative mitral valve disease
- Infective endocarditis
- Congenital mitral valve anomaly
Answer: A. Fused mitral leaflets, shortened chordae, left atrial enlargement, and atrial fibrillation are classic findings of chronic rheumatic heart disease. It is a common cause of mitral valve disease and predisposes to atrial fibrillation and embolic strokes.
A 49-year-old woman with poorly controlled atrial fibrillation dies after a stroke. Autopsy shows fused mitral leaflets, shortened chordae, and thrombus-filled enlarged left atrium. What is the most likely underlying cause?
- Rheumatic heart disease
- Hypertrophic cardiomyopathy
- Dilated cardiomyopathy
- Ischemic heart disease
Answer: A. Fused mitral leaflets and shortened chordae are characteristic pathological findings of rheumatic heart disease, a sequela of recurrent streptococcal infections. This can lead to significant mitral valve dysfunction, left atrial enlargement, thrombus formation, and an increased risk of embolic stroke, especially in the context of atrial fibrillation.
A 49-year-old woman with poorly controlled atrial fibrillation dies after a stroke. Autopsy shows fused mitral leaflets, shortened chordae, and thrombus-filled enlarged left atrium. Most likely underlying cause?
- Rheumatic heart disease
- Mitral valve prolapse
- Bicuspid aortic valve
- Dilated cardiomyopathy
Answer: A. Fused mitral leaflets, shortened chordae, and left atrial enlargement with thrombus formation are characteristic pathological findings of chronic rheumatic heart disease affecting the mitral valve, leading to mitral stenosis and atrial fibrillation, which increases the risk of stroke.
A 49-year-old woman with poorly controlled atrial fibrillation dies after a stroke. Autopsy shows fused mitral leaflets, shortened chordae, and thrombus-filled enlarged left atrium. Most likely underlying cause?
- Rheumatic heart disease
- Hypertrophic cardiomyopathy
- Dilated cardiomyopathy
- Congenital mitral valve anomaly
Answer: A. Fused mitral leaflets, shortened chordae, an enlarged left atrium with thrombus, and a history of atrial fibrillation and stroke are characteristic findings of rheumatic heart disease, which is a sequela of rheumatic fever. This leads to progressive mitral valve damage.
A 49-year-old woman with poorly controlled atrial fibrillation dies after a stroke. Autopsy shows fused mitral leaflets, shortened chordae, and thrombus-filled enlarged left atrium. Most likely underlying cause?
- Rheumatic heart disease
- Mitral valve prolapse
- Endocarditis
- Bicuspid aortic valve
Answer: A. Fused mitral leaflets, shortened chordae, and left atrial enlargement with thrombus formation are characteristic pathological findings of chronic rheumatic heart disease affecting the mitral valve. Poorly controlled atrial fibrillation is a common complication, and thrombus in the enlarged left atrium is a major cause of stroke due to embolization.