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APEA 3P STUDY GUIDE SPECIF TO
2025/26 SITTING EXAM
Cardiovascular
Atrial fibrillation (AF)
Pathophysiology: Atrial fibrillation (AF) is a cardiac arrhythmia characterized
by irregular and rapid atrial electrical activity, resulting in ineffective atrial
contractions. Instead of the normal coordinated contraction, the atria
fibrillate or quiver, leading to irregular ventricular response and inefficient
blood pumping. AF is often associated with underlying heart conditions such
as hypertension, coronary artery disease, valvular heart disease, or
structural abnormalities.
Assessment Findings:
• Palpitations: Irregular, rapid, or pounding sensation in the chest due to
irregular heartbeats.
• Fatigue: Feeling tired or exhausted due to inefficient blood pumping
and reduced cardiac output.
• Dyspnea: Shortness of breath or difficulty breathing, especially during
exertion, caused by reduced oxygen delivery.
• Dizziness or lightheadedness: Feeling faint or woozy, sometimes
accompanied by dizziness or loss of balance.
• Chest discomfort: Some individuals may experience chest pain,
pressure, or discomfort, although it is less common in AF.
• Syncope: Fainting or loss of consciousness may occur in severe cases
or when underlying heart disease is present.
Pharmacology: The pharmacological management of atrial fibrillation focuses
on controlling the heart rate, restoring and maintaining normal sinus rhythm,
and preventing blood clot formation.
Rate Control Medications:
• Beta-blockers (e.g., metoprolol, propranolol): Reduce heart rate and
decrease the frequency of irregular heartbeats.
• Calcium channel blockers (e.g., diltiazem, verapamil): Slow the heart
rate by blocking calcium channels in the heart.
Rhythm Control Medications:
• Antiarrhythmic drugs (e.g., amiodarone, flecainide, propafenone): Used
to convert and maintain normal sinus rhythm by suppressing abnormal
electrical activity in the atria.
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• Electrical cardioversion: In some cases, a synchronized electric shock
may be administered under anesthesia to restore normal sinus rhythm.
Anticoagulation Therapy:
• Anticoagulant medications (e.g., warfarin, direct oral
anticoagulants like dabigatran, rivaroxaban): Given to prevent
blood clot formation and reduce the risk of stroke or systemic
embolism, as AF increases
the risk of blood clot formation in the atria.
PAD
Pathophysiology: Peripheral artery disease (PAD) is a condition characterized
by the narrowing or blockage of the arteries that supply blood to the limbs,
typically the lower extremities. It is most caused by atherosclerosis, a
buildup of fatty deposits (plaques) in the arterial walls, leading to reduced
blood flow and oxygen supply to the muscles and tissues. Risk factors for
PAD include smoking, diabetes, hypertension, hyperlipidemia, and advancing
age.
Assessment Findings:
• Intermittent claudication: Cramping pain, aching, or fatigue in the
muscles of the lower extremities (usually calves, thighs, or buttocks)
during exercise or activity. Pain typically subsides with rest.
• Diminished or absent pulses: Weak or absent arterial pulses in the
affected limbs, especially in the lower extremities.
• Skin changes: Cool skin temperature, pallor, or cyanosis (bluish
discoloration) of the affected limb due to reduced blood flow.
• Hair loss: Decreased hair growth or absence of hair on the legs or feet.
• Delayed wound healing: Ulcers or sores on the lower extremities that
are slow to heal or don't heal completely.
• Numbness or tingling: Sensation of numbness, tingling, or weakness in
the affected limb.
• Erectile dysfunction: In men, PAD can lead to erectile dysfunction due
to impaired blood flow to the genital area.
Pharmacology: The pharmacological management of peripheral artery
disease aims to relieve symptoms, improve functional status, and reduce the
risk of cardiovascular events. Medications commonly used in PAD include:
• Antiplatelet agents: Aspirin, clopidogrel, or ticagrelor are used to
reduce the risk of blood clot formation and subsequent cardiovascular
events.
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APEA 3P STUDY GUIDE SPECIF TO
2025/26 SITTING EXAM
Cardiovascular
Atrial fibrillation (AF)
Pathophysiology: Atrial fibrillation (AF) is a cardiac arrhythmia characterized
by irregular and rapid atrial electrical activity, resulting in ineffective atrial
contractions. Instead of the normal coordinated contraction, the atria
fibrillate or quiver, leading to irregular ventricular response and inefficient
blood pumping. AF is often associated with underlying heart conditions such
as hypertension, coronary artery disease, valvular heart disease, or
structural abnormalities.
Assessment Findings:
• Palpitations: Irregular, rapid, or pounding sensation in the chest due to
irregular heartbeats.
• Fatigue: Feeling tired or exhausted due to inefficient blood pumping
and reduced cardiac output.
• Dyspnea: Shortness of breath or difficulty breathing, especially during
exertion, caused by reduced oxygen delivery.
• Dizziness or lightheadedness: Feeling faint or woozy, sometimes
accompanied by dizziness or loss of balance.
• Chest discomfort: Some individuals may experience chest pain,
pressure, or discomfort, although it is less common in AF.
• Syncope: Fainting or loss of consciousness may occur in severe cases
or when underlying heart disease is present.
Pharmacology: The pharmacological management of atrial fibrillation focuses
on controlling the heart rate, restoring and maintaining normal sinus rhythm,
and preventing blood clot formation.
Rate Control Medications:
• Beta-blockers (e.g., metoprolol, propranolol): Reduce heart rate and
decrease the frequency of irregular heartbeats.
• Calcium channel blockers (e.g., diltiazem, verapamil): Slow the heart
rate by blocking calcium channels in the heart.
Rhythm Control Medications:
• Antiarrhythmic drugs (e.g., amiodarone, flecainide, propafenone): Used
to convert and maintain normal sinus rhythm by suppressing abnormal
electrical activity in the atria.
,2
,3
• Electrical cardioversion: In some cases, a synchronized electric shock
may be administered under anesthesia to restore normal sinus rhythm.
Anticoagulation Therapy:
• Anticoagulant medications (e.g., warfarin, direct oral
anticoagulants like dabigatran, rivaroxaban): Given to prevent
blood clot formation and reduce the risk of stroke or systemic
embolism, as AF increases
the risk of blood clot formation in the atria.
PAD
Pathophysiology: Peripheral artery disease (PAD) is a condition characterized
by the narrowing or blockage of the arteries that supply blood to the limbs,
typically the lower extremities. It is most caused by atherosclerosis, a
buildup of fatty deposits (plaques) in the arterial walls, leading to reduced
blood flow and oxygen supply to the muscles and tissues. Risk factors for
PAD include smoking, diabetes, hypertension, hyperlipidemia, and advancing
age.
Assessment Findings:
• Intermittent claudication: Cramping pain, aching, or fatigue in the
muscles of the lower extremities (usually calves, thighs, or buttocks)
during exercise or activity. Pain typically subsides with rest.
• Diminished or absent pulses: Weak or absent arterial pulses in the
affected limbs, especially in the lower extremities.
• Skin changes: Cool skin temperature, pallor, or cyanosis (bluish
discoloration) of the affected limb due to reduced blood flow.
• Hair loss: Decreased hair growth or absence of hair on the legs or feet.
• Delayed wound healing: Ulcers or sores on the lower extremities that
are slow to heal or don't heal completely.
• Numbness or tingling: Sensation of numbness, tingling, or weakness in
the affected limb.
• Erectile dysfunction: In men, PAD can lead to erectile dysfunction due
to impaired blood flow to the genital area.
Pharmacology: The pharmacological management of peripheral artery
disease aims to relieve symptoms, improve functional status, and reduce the
risk of cardiovascular events. Medications commonly used in PAD include:
• Antiplatelet agents: Aspirin, clopidogrel, or ticagrelor are used to
reduce the risk of blood clot formation and subsequent cardiovascular
events.
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