




版权说明:本文档由用户提供并上传,收益归属内容提供方,若内容存在侵权,请进行举报或认领
文档简介
1、Atrial Fibrillation a simple pulse check to prevent a stroke?,Dr Kneale Metcalf,Overview,Atrial fibrillation Stroke and atrial fibrillation Detecting atrial fibrillation Managing atrial fibrillation,What is atrial fibrillation (AF)?,“Atrial fibrillation is an atrial tachyarrhythmia characterised by
2、predominantly uncoordinated atrial activation”,“A fast / irregular heart”,What happens in the heart?,Sinus rhythm,AF,ECG,Most commonly diagnosed by an ECG:,Classification of AF,The Incidence of AF is Increasing in the United Kingdom,In 1995, 0.9% of the United Kingdom population were affected by AF2
3、 By 2006 this figure had risen to 1.3%1 The prevalence of AF will continue to rise as the proportion of elderly patients increases By 2050, it is estimated that AF will be present in 2% of the general population, and in a far higher proportion of elderly patients2,NICE Clinical Guideline 36 costing
4、report. Available at: .uk/nicemedia/pdf/CG036costingreport.pdf. Accessed January 14, 2010 Stewart S, et al. Heart 2004; 90: 28692; 3. Savelieva I, et al. Europace 2008; 10: 64765,Other points about AF,Can be symptomatic or asymptomatic If asymptomatic then how do you pick it up?,Co
5、re message,Atrial fibrillation is common and getting commoner,AF and stroke,Wolf et al. Stroke 1991; 22: 983-988,One sixth of all strokes are attributable to AF,AF is an Independent Risk Factor for Stroke,AF patients have nearly a fivefold increased risk of stroke compared with patients without AF1,
6、1. Wolf PA, et al. Stroke 1991; 22: 9838,5059,6069,7079,8089,4,3,2,1,0,5,Age (years),4.0,2.6,3.3,4.5,Relative risk of stroke compared to patients without AF,p0.001 for all age groups,The Impact of AF on Stroke Outcomes,Survival is poorer and stroke recurrence rates are higher following AF-related st
7、roke,AF=atrial fibrillation; OR=odds ratio; CI=confidence interval 1. Lin HJ, et al. Stroke 1996; 27: 17604; 2. Dulli DA, et al. Neuroepidemiology 2003; 22: 11823,Framingham (10-year follow up from 1981),AF=atrial fibrillation; OR=odds ratio; CI=confidence interval Dulli DA, et al. Neuroepidemiology
8、 2003; 22: 11823,Patients bedridden on admission (%),p0.0005,40,30,20,10,0,50,41.2%,23.7%,With AF(n=194),Without AF(n=867),Functional outcomes of stroke are significantly worse in patients with AF, and more patients remain bedridden,OR for bedridden state following stroke due to AF was 2.23 (95% CI:
9、 1.87, 2.59),The Impact of AF on Stroke Outcomes,Core message,Atrial fibrillation causes stroke,Detecting AF,Detecting AF,Pulse ECG 24hr ECG Fancy kit,AF how can it be diagnosed?,ECG (preferably 12-lead) Still the cornerstone of AF diagnosis,Opportunistic screening,Taken up by 2 PBC Consortia this y
10、ear in Norfolk during flu vaccination IDEAL setting High risk patients Nurse vaccination Done to protocol GP paid! Evidence of effectivness N Essex screened 30000 in 6 weeks 361 patients newly diagnosed with AF,Protocol,Patients aged over 65 years, who have no record of AF, will have their pulse che
11、cked for at least 30 seconds to look for irregularity. If irregularity is identified, then they will be followed up with: resting 12-lead ECG blood tests for lipid profile, renal function, fasting glucose, full blood count, thyroid function body mass index urinalysis clinical assessment of cardiovas
12、cular system overall evaluation of cardiovascular risk Management options will include: warfarin (or antiplatelet agents if warfarin contraindicated) pulse rate control consideration of referral for cardioversion.,24 hr ECG (and longer),As AF can be paroxysmal then one off pulse or ECG may miss! 24
13、hr ECG may have a better pick up,Effectiveness of different rhythm detectors,Jabaudon D, Sztajzel J, Sievert K et al. Usefulness of ambulatory 7-day ECG monitoring for the detection of atrial fibrillation and flutter after acute stroke and transient ischemic attack. Stroke. 2004;35(7):16471651.,CARD
14、IST Trial,Patients with stroke or TIA No Hx AF 24 hr ECG, 7 day automated device, wrist watch device Comparing AF pick up rate,Core message,AF can be detected by a simple pulse check,Managing AF,Blood thinning Antiplatelets Anticoagulation Rhythm control Rate Stabalisation Operations,The CHADS2 Scor
15、ing System,CHADS2 is a points-based system for predicting risk of stroke in AF based on key risk factors1 Congestive heart failure 1 point Hypertension 1 point Age 75 years 1 point Diabetes mellitus 1 point Stroke or TIA 2 points,Aspirin,Stroke reduction of 19% (95% CI 2% to 34%),Warfarin,Risk reduction of 62% (95% CI 48% to 72%) versus placebo,RE-LY Trial (Dabigatran),Dabigatran Direct thrombin inhibitor NON MONITORED ANTICOAGULATION 18000 patients, compared to warfarin 150mg better than warfarin (RRR 34%),Rate / rhythm control,Beta blockers Amiodarone Flecainide Digoxin Etc. Ne
温馨提示
- 1. 本站所有资源如无特殊说明,都需要本地电脑安装OFFICE2007和PDF阅读器。图纸软件为CAD,CAXA,PROE,UG,SolidWorks等.压缩文件请下载最新的WinRAR软件解压。
- 2. 本站的文档不包含任何第三方提供的附件图纸等,如果需要附件,请联系上传者。文件的所有权益归上传用户所有。
- 3. 本站RAR压缩包中若带图纸,网页内容里面会有图纸预览,若没有图纸预览就没有图纸。
- 4. 未经权益所有人同意不得将文件中的内容挪作商业或盈利用途。
- 5. 人人文库网仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对用户上传分享的文档内容本身不做任何修改或编辑,并不能对任何下载内容负责。
- 6. 下载文件中如有侵权或不适当内容,请与我们联系,我们立即纠正。
- 7. 本站不保证下载资源的准确性、安全性和完整性, 同时也不承担用户因使用这些下载资源对自己和他人造成任何形式的伤害或损失。
最新文档
- 土地利用测量与规划合同
- 彩妆造型美妆产品研发与市场调研合同
- 老北京胡同文化课件
- 老人跌倒护理课件
- 翻锅技术课件下载
- 翻译说课课件
- 2025年度国家绿色数据中心自评价报告
- 统计专业培训课件
- 小贷入职培训课件
- 对排查发现的重大事故隐患应及时向什么报告
- 物业消防检查培训课件
- 专题 完形填空 七年级英语下册期末复习考点培优专项北师大版(2024版)(含答案解析)
- 余料使用管理制度
- 2025至2030年中国彩涂铝材行业市场动态分析及发展趋向研判报告
- 农业面源防治课件
- 2025至2030中国氨基吡啶行业项目调研及市场前景预测评估报告
- 2025-2030中国商业展示道具市场应用前景及投资价值评估报告
- 拉萨市墨竹工卡县思金拉措小学-2025年春季英语教研组工作总结-一路求索不停歇【课件】
- 山东省菏泽市2023−2024学年高一下学期7月期末考试 数学试题(含解析)
- (三级)人工智能训练师职业技能鉴定理论考试题(附答案)
- 2025杭州市临安区事业单位招聘80人考前自测高频考点模拟试题附答案详解(巩固)
评论
0/150
提交评论