atrial fibrillation1 Flashcards
at what rate do the atria pump when in AF
400-600 atrial bpm
what is “saving grace” in AF
AV node; filters impulses.keeps them from enterring the ventricles (quivering ventricle = death in seconds)
what does irregularly irregular mean
totally random sinus rhythm (pulse); incalculable
multiple p-waves, random impulse firing.
what is meant by “AF begets AF”
incidence for this goes up after an occurance
what are common symptoms of AF?
palpitations
weakness
fatigue
what are 3 signs of AF?
- irregularly irregular pulse
- irregular jugular pulsations
- ECG; P waves aren’t present or undulating isoelectric line with sporadic QRS complexes
what are two major complications that needed to be protected against for AF patients?
- stroke - clots form as blood becomes more static
2. ventricular arrhythmia
what should be done for new onset AF with hemodynamic instability
- control heart rate (< 100 bpm)
- full dose IV anticoagulation
- cardioversion
- continue anticoagulation for 4 weeks
what is cardioversion?
how is it done?
restoring normal sinus rhythm
shock or drug tx (usually shock)
what type of cardioversion is usually used
DCC shock
why does anticoagulation need to continue for 4 weeks after cardioversion
cardiac output will be low and blood will be sluggish for a few weeks (increased risk of stroke)
what should be done immediately for new onset AF with pt’s who are stable?
what can be done to acheive this
heart rate control of less than 100 bpm.
use diltiazem, B-Blocker, or digoxin
what shoud be done if NSR is not acheived in first treatment of stable new onset AF?
- find out how long pt. has been in AF
what is the window of opportunity with AF?
why?
first 48 hours of AF does not have high risk of stroke or clot.
after 48 hours high risck for stroke
what should be done if stable new onset AF pt. has been in AF for less than 48 hours
cardioversion and 4 weeks of anticoagulation
what should be done if stable new onset AF pt. has been in AF for more than 48 hours
- 3 weeks of being in therapeutic range of anticoagulation for 3 weeks
- Then cardioversion after (with drugs or electricity)
- 4 more weeks of anticoagulations
what should be done if stable new onset AF pt. has been in AF for more than 48 hours with no response to cardioversion
consider accepting permanent AF and begin a long term rate control strategy
if a patient is determined to have new onset AF what do we not care about?
what do we care about?
don’t care about CHADs score or rate and rhythm control
are they hemodynamically stable
what indicates a patient is not hemodynamically stable?
what does not indicate if pt. is hemodynamically stable?
unconscious, in ICU with life threatening illness
high heart rate does not always mean not stable
why would you not cardioconvert a new onset AF patient who is hemodynamically
If they have had 48 hours or more of AF must be put on anticoagulation treatment first, then convert once at therapeutic level
what should be done with a patient after converted to normal sinus rhythm
4 weeks of anticoagulation
