ARRHYTHMIAS
, Atrial Fibrillation
Risk Factors Presentation
• Old age • Asymptomatic
• Hypertension • Palpitations
• Hyperthyroidism • Shortness of breath
• Ischemia: MI / PE • Lightheadedness / syncope
• Cardiomyopathy • Acute pulmonary edema
• Mitral stenosis • Irregularly irregular rate
• Caffeine
• Alcohol
• Cocaine
W/rapid ventricular response
350bpm: CHF symptoms
, Atrial Fibrillation
Diagnosis Others
• ECG initially • ECHO
- no P waves - if not done in last 6 months
- flat or chaotic baseline - clots, valve function
- irregularly irregular narrow QRS - left atrial size / TTE TEE
• Telemetry monitoring • TSH
• Holter monitor • Electrolytes
- hemodynamically stable - Potassium
- Magnesium
• Troponin / CK-MB - Calcium levels
- Acute onset
, Treatment- stable
Control ♥
rate / rhythm Anticoagulation
• Best Initial • Warfarin
-♥rate <100-110 - INR between 2-3
- Beta blockers - For as long as AFib there
- Calcium channel blockers - Dibigatran alternative
0.25/KG IV for 12hrs PO - stroke risk
• if BP • Heparin
- Digoxin - if clot present
- before starting warfarin
WAIT 48hrs:
may cardiovert on own
, Atrial Fibrillation
Risk Factors Presentation
• Old age • Asymptomatic
• Hypertension • Palpitations
• Hyperthyroidism • Shortness of breath
• Ischemia: MI / PE • Lightheadedness / syncope
• Cardiomyopathy • Acute pulmonary edema
• Mitral stenosis • Irregularly irregular rate
• Caffeine
• Alcohol
• Cocaine
W/rapid ventricular response
350bpm: CHF symptoms
, Atrial Fibrillation
Diagnosis Others
• ECG initially • ECHO
- no P waves - if not done in last 6 months
- flat or chaotic baseline - clots, valve function
- irregularly irregular narrow QRS - left atrial size / TTE TEE
• Telemetry monitoring • TSH
• Holter monitor • Electrolytes
- hemodynamically stable - Potassium
- Magnesium
• Troponin / CK-MB - Calcium levels
- Acute onset
, Treatment- stable
Control ♥
rate / rhythm Anticoagulation
• Best Initial • Warfarin
-♥rate <100-110 - INR between 2-3
- Beta blockers - For as long as AFib there
- Calcium channel blockers - Dibigatran alternative
0.25/KG IV for 12hrs PO - stroke risk
• if BP • Heparin
- Digoxin - if clot present
- before starting warfarin
WAIT 48hrs:
may cardiovert on own
