Atrial Fibrillation

Atrial Fibrillation

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Notice the irregular RR interval with absence of P waves which is characteristic feature of Atrial fibrillation. You can differentiate from multifocal atrial tachycardia which has >3 morphology of P waves present.
Common causes of Atrial fibrillation: ABCD- OT

  1. Age: 60 years old
  2. Blood Pressure high /Hypertension
  3. Cardiac conditions: Coronary artery disease, Cardiac valve disorders, congenital heart defects
  4. COPD
  5. Diabetes: Individuals with diabetes have an elevated risk of developing AFib.
  6. Dilated Cardiomyopathy due to long term alcohol intake leading to Holiday heart syndrome
  7. Obstructive sleep apnea
  8. Thyroid disease


Clinical features of Atrial fibrillation

  1. Irregular Heartbeat: The hallmark of AFib is an irregular and often rapid heartbeat. The pulse may feel chaotic and irregular when palpating the wrist.
  2. Palpitations: Some individuals with AFib may feel palpitations, which are sensations of rapid, fluttering, or pounding heartbeats.
  3. Fatigue: AFib can lead to reduced cardiac output, causing fatigue and a sense of low energy.
  4. Shortness of Breath: Pooling of blood in lungs due to Inability of the heart to pump blood effectively can result in shortness of breath, especially during physical activity.
  5. Dizziness or Lightheadedness: Inadequate blood flow to the brain due to irregular heartbeats can cause dizziness or lightheadedness.
  6. Chest Pain or Discomfort While chest pain is not as common in AFib as it is in some other heart conditions, some individuals may experience chest discomfort.
  7. Syncope (Fainting): In severe cases, AFib can lead to a drop in blood pressure, causing fainting or loss of consciousness.
  8. Increased Risk of Stroke: A.Fib is associated with an increased risk of blood clot formation in the atria, which can travel to the brain and cause a stroke. Some individuals may not have noticeable symptoms but are at risk of stroke.

Creating a mnemonic can be a helpful memory aid for remembering the treatment of atrial fibrillation. Here’s a mnemonic for the general principles of AFib treatment:

Management of Atrial fibrillation: RACE (Remembering “RACE” can help you recall the key components of atrial fibrillation treatment)

  1. Rate Control: Use medications to control the heart rate, preventing it from becoming too fast. Common medications include beta-blockers, calcium channel blockers, and sometimes digoxin.
  2. Anticoagulation: Reduce the risk of blood clots and stroke by prescribing anticoagulant medications. Common options include warfarin, dabigatran, rivaroxaban, apixaban. For Rheumatic heart disease leading to MS and then atrial fibrillation warfarin is preferred. For Non valvular atrial fibrillation, NOAC are preferred.
  3. Chemical Cardioversion: Convert the irregular rhythm back to a normal sinus rhythm. This can be achieved through electrical cardioversion (shocks) or pharmacological cardioversion using medications like amiodarone.
  4. Electrical cardioversion: Synchronized DC shock
  5. Evaluate and Treat Underlying Causes: Identify and manage any underlying conditions contributing to atrial fibrillation, such as hypertension, heart valve disorders, or thyroid problems

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