Flashcards in Atrial Fibrillation Deck (6):
What is Atrial Fibrillation?
Atrial Fibrillation is a condition in which the atria fail to contract efficient, and depolarise spontaneously in a rapid, uncoordinated fashion. This results in some of these impulses being sent to the AVN and as such an irregularly irregular ventricular pulse occurs. The impaired contraction of the atria can cause stagnation of blood, leading to thrombus formation and a risk of embolism, which could go on to cause stroke. It can also cause a reduction in cardiac output which may lead to heart failure.
There are 3 main types of atrial fibrillation:
Paroxysmal AF - attacks start and stop without intervention
Persistent AF - Attacks do not stop spontaneously and require medical help to stop them
Permanent AF - AF where medical treatment cannot maintain sinus rhythm
What are the causes of Atrial Fibrillation?
Common - Ischaemic heart disease, Hypertension, Valvular heart disease, Hyperthyroidism, Infection, Caffeine, Alcohol
Others - Pericarditis and cardiomyopathy, Heart failure, Alcohol, Pulmonary embolism, pneumonia, COPD, Cor pulmonale, Idiopathic
What will you find on a history taking of Atrial Fibrillation?
Fast irregular palpitations - Sudden onset, defined duration, sudden offset
Breathlessness - More common in patients with underlying hearty disease
General Malaise, tiredness
Specific Questions to ask:
Black outs - very uncommon in AF
Ask about the type of palpitations - Non-cardiac palpitations come on gradually and not suddenly
Another type of Arrhythmia
What will you find on examination of Atrial Fibrillation?
End of the bed:
Fever – Infection can be a cause
Fast or Slow heart rate
Irregularly irregular pulse
Hypertension – Can be a cause
Radial-Apical Pulse deficit (Not every apical beat can be felt at radial pulse)
Goitre – Hyperthyroidism can be a cause
Thyroid eye disease - Hyperthyroidism can be a cause
Heart Failure – Can be caused by AF
Oedema – Due to heart failure
What investigations will you order in Atrial Fibrillation?
ECG - Irregularly Irregular, no P waves
24-hour ambulatory ECG monitor - If paroxysmal and frequent enough to be picked up in 24 hours
Event recorder ECG - If paroxysmal and not frequent enough for 24-hour monitoring
TFTs - Rule out hyperthyroidism
FBC - Anaemia may precipitate heart failure
U&E - Abnormal Potassium levels can potentiate arrhythmias and patient may be given digoxin
LFTs and coagulation screen – Given pre-warfarin
CXR – Looking for heart failure
Transthoracic echocardiography - Looking for valve disease, heart failure or looking for clots pre cardioversion