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Notes On Atrial Fibrillation

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Published in: Medical | Pharmacology
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Short notes of Atrial Fibrillation (a very common heart arrhythmia) explained in a very simple brief way with help of a case scenario,clinical picture and ECG.

Faiza A / Dubai

8 years of teaching experience

Qualification: M.B.B.S,

Teaches: Anatomy, Physiology, Medical, Medicine

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  1. ATRIAL FIBRILLATION: CLINICAL SCENARIO TO EXPLAIN: 68 years old male patient, who presented to the emergency department with complaints of increasing shortness of breath, dizziness, and the sensation of his "heart racing. Patient said that his symptoms started abruptly earlier that day and have steadily become worse. He reports a history of long-standing hypertension, coronary artery disease, and a recent percutaneous transluminal angioplasty with placement of two stents. Patient also confirmed about no known drug allergies Vitals on arrival: HR: 160 bpm BP:100/50 R/R: 26 oxygen sats 88% @room air. On Examination: Tachypneic, Tachycardic, Febrile Lungs: Crackles B/L lungs present, no wheeze CVS: Peripheral pulses are diminished and irregular. Patient's skin is cool but dry A 12-lead ECG was obtained. It showed a narrow QRS complex tachycardia with an irregularly irregular rhythm RISK FACTORS: MAJOR: 1)Hypertension 2)CAD 3)+VE Family history 4)Heart failure 5)Congenital heart disease MINOR: 1)Thyroid issues 2)DM 3)CKD 4)Obesity 5)Lung pathology like COPD But AFIB is itself a risk factor for "STROKE"
  2. COMMON SIGNS AND SYMPTOMS: Fatigue, palpitations, chest pain, syncope, dizziness, dyspnea, and orthopnea. Sleep apnea cardiac murmurs (such as aortic or mitral stenosis) and evidence of heart failure (pulmonary rales, S3 gallop, peripheral pulses, and jugular venous distention DIAGNOSIS: ->Mainly by 12 leads ECG ->Holter monitoring for 24 hours ->echocardiogram to diagnose structural heart disease or blood clots in the heart. •Blood tests to rule out thyroid problems or other substances in your blood that may lead to atrial fibrillation. ->Chest X-ray to see the condition of lungs and heart. Also to diagnose conditions other than atrial fibrillation that may explain your signs and symptoms. TREATMENT: (A) Newly Onset Atrial Fibrillation which is divided into stable and unstable patient. Stable Patient:(No chest pain, no hypotension) treatment goal is Calcium channel blocker like IV Diltiazem • If there will be Spontaneous conversion into sinus rhythm->Observe->Access cause of Atrial Fibrillation->remained stable-> Give follow up and discharge. • If no Spontaneous conversion into sinus rhythm-> after sedation, consider electric Cardioversion Unstable Patient:(shortness of breath, chest pain, hypotension): Cardioversion (B)Chronic Afib: treatment goal is to restore normal heart rate and rhythm and treat any underlying conditions that may cause AFib. beta-blockers calcium channel blockers, or digitalis for rate control and antiarrhythmics for rhythm control like flecainide. Blood thinners like warfarin , rivaroxaban are usually prescribed to reduce blood clots.
  3. Patient 'Mth diagnosis of atrial fibrillation Hemodynamically stable (no angina. no hypotension, etc.)? Control ventricular rate (goal — <ICO tEats p« minute): administer diltiazem (Cardizem). 15 IV over 2 minutes, then 5 to 15 per hour by continuous IV infusion cr administer other rate-control drug (see Table 1). COrM>rsion to sinus rhythm? Electrical card cn«sion: sedate, then shock (100 J, 200 J. 300 J. 360 J) until Sinus rhythn-t returns. Assess cause of atrial fibrillation; hospital follow-up Contraindications to cardio-version? Img.terrn Consider cardioversion. if (see text): Start heparin IV; then choose— Atrial fibrillation < 48 hours: immediate rnedical or ekxtrical cardioversion Atrial fibrillation > 48 hours unknovm duration: Later cardioversjon (ekxtric.al cardim•ersion with without medical cardioversion) after 3 weeks of war-farin (Coumadin) EMty (e ectrical cardiovgsion with Witrn..'t rredtal c"oversion) Atrial fibrillation persists? Consider bng.terrn anticoagulation. Penned by Dr Faiza Akhlaque No Assess cat_ße of atrial fibrillation: hospta disch&ge,

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