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16 terms

ATRIAL FIBRILLATION

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atrialfibrillation
disorganized, rapid, and irregular atrial activation; ventricular response is also irregular
afib etiologies
(reversible) acute hyperthyroidism, an acute vagotonic episode, or acute alcohol intoxication (holiday heart)
symptoms
dizziness, palpitations, syncope, fatigue, exercise intolerance
complication
thromboembolism-->stroke
diagnosis
ECG: irregularly irregular R-R interval, absence of P waves, NARROW QRS complex
acute
new onset, lasts < 48hr
paroxysmal
recurrent, last <48 hr, spontaneously converts to sinus rhythm
persistent
lasts >1 wk, requires conversion to normal sinus rhythm
permanent
can't be converted to sinus rhythm, usu due to atrial remodeling
rate control
β-Blockers, verapamil, diltiazem, Digoxin, amiodarone
rhythm control
prior to conversion, control ventricular rate*
Synchronized cardioversion or pharmacological
>48hr duration treatment
anticoagulation > 3 wk before conversion & at least 4 wk after cardioversion
risk factors
thromboemolism, age ≥ 75 years, HTN, DM, heart failure, prior stroke or TIA, rheumatic heart disease (especially mitral stenosis) or mechanical heart valve
Who is treated with aspirin as opposed to coumadin/warfarin?
patients with no risk factors for thromboembolism or those with contraindications to oral anticoagulation.
Afib + WIDE QRS complex may indicate______ therefore DO NOT use _________ because they may cause ______ which may be______.
wolff-parkinson-white syndrome; AV node blocking drugs (CCB, beta blockers); ventricular fibrillation; fatal
How do you treat patients who do not respond to or cannot take rate-controlling drugs?
radiofrequency ablation of the AV node to cause complete heart block; insertion of a permanent pacemaker is then necessary