atrial fibrillation1

Question 1

at what rate do the atria pump when in AF

Answer 1

400-600 atrial bpm

Question 2

what is “saving grace” in AF

Answer 2

AV node; filters impulses.keeps them from enterring the ventricles (quivering ventricle = death in seconds)

Question 3

what does irregularly irregular mean

Answer 3

totally random sinus rhythm (pulse); incalculable

multiple p-waves, random impulse firing.

Question 4

what is meant by “AF begets AF”

Answer 4

incidence for this goes up after an occurance

Question 5

what are common symptoms of AF?

Answer 5

palpitations
weakness
fatigue

Question 6

what are 3 signs of AF?

Answer 6

1. irregularly irregular pulse
2. irregular jugular pulsations
3. ECG; P waves aren’t present or undulating isoelectric line with sporadic QRS complexes

Question 7

what are two major complications that needed to be protected against for AF patients?

Answer 7

1. stroke - clots form as blood becomes more static

2. ventricular arrhythmia

Question 8

what should be done for new onset AF with hemodynamic instability

Answer 8

1. control heart rate (< 100 bpm)
2. full dose IV anticoagulation
3. cardioversion
4. continue anticoagulation for 4 weeks

Question 9

what is cardioversion?

how is it done?

Answer 9

restoring normal sinus rhythm

shock or drug tx (usually shock)

Question 10

what type of cardioversion is usually used

Answer 10

DCC shock

Question 11

why does anticoagulation need to continue for 4 weeks after cardioversion

Answer 11

cardiac output will be low and blood will be sluggish for a few weeks (increased risk of stroke)

Question 12

what should be done immediately for new onset AF with pt’s who are stable?
what can be done to acheive this

Answer 12

heart rate control of less than 100 bpm.

use diltiazem, B-Blocker, or digoxin

Question 13

what shoud be done if NSR is not acheived in first treatment of stable new onset AF?

Answer 13

1. find out how long pt. has been in AF

Question 14

what is the window of opportunity with AF?

why?

Answer 14

first 48 hours of AF does not have high risk of stroke or clot.
after 48 hours high risck for stroke

Question 15

what should be done if stable new onset AF pt. has been in AF for less than 48 hours

Answer 15

cardioversion and 4 weeks of anticoagulation

Question 16

what should be done if stable new onset AF pt. has been in AF for more than 48 hours

Answer 16

1. 3 weeks of being in therapeutic range of anticoagulation for 3 weeks
2. Then cardioversion after (with drugs or electricity)
3. 4 more weeks of anticoagulations

Question 17

what should be done if stable new onset AF pt. has been in AF for more than 48 hours with no response to cardioversion

Answer 17

consider accepting permanent AF and begin a long term rate control strategy

Question 18

if a patient is determined to have new onset AF what do we not care about?
what do we care about?

Answer 18

don’t care about CHADs score or rate and rhythm control

are they hemodynamically stable

Question 19

what indicates a patient is not hemodynamically stable?

what does not indicate if pt. is hemodynamically stable?

Answer 19

unconscious, in ICU with life threatening illness

high heart rate does not always mean not stable

Question 20

why would you not cardioconvert a new onset AF patient who is hemodynamically

Answer 20

If they have had 48 hours or more of AF must be put on anticoagulation treatment first, then convert once at therapeutic level

Question 21

what should be done with a patient after converted to normal sinus rhythm

Answer 21

4 weeks of anticoagulation