Long-standing persistent Afib: continuous Afib for > 1 year.Afib with slow ventricular response: Afib with a ventricular rate 7 days.Afib with rapid ventricular response: Afib with a ventricular rate > 100–110/minute ( tachycardic Afib).Stable Afib: Afib without signs of hemodynamic instability.Unstable Afib: Afib manifesting with signs of hemodynamic instability (e.g., chest pain, altered mental status, acute pulmonary edema, hypotension, or cardiogenic shock ).Remember PARASITE to memorize the major risk factors for acute Afib: P – Pulmonary disease A – Anemia R – Rheumatic heart disease A – Atrial myxoma S – Sepsis I – Ischemia T – Thyroid disease E – Ethanol. 15% of individuals who develop Afib have none of the above mentioned risk factors ( idiopathic/lone Afib). Other triggers of tachycardia: e.g., pain, hypovolemia, anemiaĪpprox.Recreational or pharmacological drug use.Reversible causes of atrial fibrillation Holiday heart syndrome : irregular heartbeat classically triggered by excessive alcohol consumption, but also sometimes by moderate alcohol consumption, stress, dehydration, or lack of sleep.Electrolyte imbalances ( hypomagnesemia, hypokalemia).Stress: sepsis, hypovolemia, post-surgical state (especially following cardiac surgery), hypothermia.Catecholamine release and/or increased sympathetic activity.Pulmonary disease: COPD, pulmonary embolism, pneumonia.Sick sinus syndrome ( tachycardia-bradycardia syndrome).e.g., Wolff-Parkinson-White ( WPW) syndrome Valvular heart disease (especially mitral valve disease).Atrial flutter frequently progresses to Afib.įor the management of atrial fibrillation with a ventricular rate > 100–110/minute, see “ Afib with RVR.” Atrial flutter is typically more responsive to ablation therapy than Afib. Treatment is also similar to that of Afib, consisting of anticoagulation and strategies to control heart rate and rhythm. In atrial flutter, the ventricular rhythm is usually regular. The risk factors for atrial flutter are similar to those of Afib. Patients are typically started on anticoagulation depending on their thrombotic and bleeding risk.Ītrial flutter is another common type of supraventricular tachyarrhythmia that is usually caused by a single macroreentrant rhythm within the atria. Rhythm control strategies include synchronized electrical cardioversion, the use of pharmacological antiarrhythmics (e.g., flecainide, propafenone, or amiodarone), and ablation of the arrhythmogenic tissue. Rate-control therapy typically involves the use of beta blockers or nondihydropyridine calcium channel blockers. In stable patients, treatment involves the correction of modifiable risk factors, rate or rhythm control strategies, and anticoagulation. Immediate synchronized cardioversion is required in hemodynamically unstable patients. Echocardiography is used to rule out structural heart disease and to evaluate for any atrial thrombi. Diagnosis is confirmed with ECG showing absent P waves with irregular QRS intervals. Ineffective atrial emptying as a result of Afib can lead to stagnation of blood and clot formation in the atria, which in turn increases the risk of stroke and other thromboembolic complications. Physical examination typically reveals an irregularly irregular pulse. When symptoms do occur, they usually include palpitations, lightheadedness, and shortness of breath. Individuals with Afib are typically asymptomatic. While the exact mechanisms of Afib are poorly understood, associations with a number of cardiac (e.g., valvular heart disease, coronary artery disease) and noncardiac (e.g., hyperthyroidism, electrolyte imbalances) risk factors have been established. Atrial fibrillation (Afib) is a common type of supraventricular tachyarrhythmia characterized by uncoordinated atrial activation that results in an irregular ventricular response.
0 kommentar(er)
