![]() ![]() If you have aCHA 2DS 2VASc scoreor 1 or more, it is now recommended you take warfarin or a Novel Oral Anticoagulant for life to reduce your risk of stroke. You still score 1 point on theCHA 2DS 2-VASc scoring system but you do not need to take warfarin ora Novel Oral Anticoagulant until or unless you score another point in the future. The only exception to this is if you are female and have no other risk factors. So, if you are 65 or older and have AF, it is now recommended you are treated with an anticoagulant for the rest of your life (and not aspirin which is now known not to be beneficial). If you have or have ever had one of these conditions you score one point for each, except age >75 or stroke/TIA which count as 2 points, henceCHA 2DS 2VASc score. V = Vascular disease (heart attack or other arterial disease).S 2= Stroke or TIA (transient ischaemic attack, or "mini-stroke").H=Hypertension (or high blood pressure). ![]() C=Congestive cardiac failure (or heart failure or impaired left ventricular function).This risk is calculated by using a scoring system called the CHA 2DS 2-VASc score. Rather it is one's overall risk for stroke that is important. The risk is not determined, as one might think, by the length of time you spend or have spent in AF. The risk of stroke is the most important adverse effect of atrial fibrillation. Common precipitants include alcohol (sometimes even very small amounts), caffeine, tiredness and stress but AF can also occur for no obvious reason or even when asleep in some people.ģD image of the left atrium – stars indicate pulmonary vein ectopics triggering AF Persistent AF The flipping in and out of rhythm when episodes occur can be very uncomfortable and sometime long pauses can occur after an episode of AF abruptly stops. Episodes can last from seconds or minutes, to hours or days. The pulmonary veins, of which there are usually four, carry blood back from the lungs to the left atrium. Paroxysmal AF (or PAF) is usually triggered by an extra heartbeat, or ectopic, from just inside one of the pulmonary veins (see figure below). It can also occur without causing symptoms in up to 25% of people with AF. Typically, the heart races very fast and irregularly and when this occurs it causes palpitations, breathlessness, lightheadedness, tiredness or even loss of consciousness. AF usually first occurs intermittently, known in medical parlance as ‘paroxysmal’.
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