Atrial Fibrillation

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Atrial Fibrillation

• disordered contraction of atria with initiation of contraction from several regions
• transmission through AV node at maximum rate of AV node (~150 bpm)

Causes

• Increased atrial pressure
• Increased atrial muscle mass
• Atrial Fibrosis
• Inflammation / Infiltration
• infectious / inflammatory
  • Pericarditis
  • Cardiomyopathy
  • Infective Endocarditis
  • Pneumonia
  • Sarcoid
• Vascular
  • Myocardial Infarction / Ischaemic Heart Disease
  • Junctional tachycardia
    • Wolff-Parkinson-White syndrome
  • Rheumatic heart disease
    • Mitral Stenosis
  • Hypertension
  • Pulmonary Embolism
  • chronic sino-atrial disease
• Neoplastic
  • Bronchial Carcinoma
  • atrial myxoma
• Metabolic
  • Hyperthyroidism
  • haemochromatosis
• Idiopathic
• Drugs
  • Acute / Chronic Alcohol abuse
• Trauma
  • Cardiac surgery
• Congenital / Genetic
  • Atrial Septal Defect

History

• palpitations
• deterioration of well-being / exercise tolerance
• worsening of Heart Failure

Examination

• observation
  • check for signs of Hyperthyroidism
• Hands
  • sweating
  • tremor
• Pulse
  • irregularly irregular pulse
  • volume irregular
• BP
• Neck
  • goitre of hyperthyroidism
• Face
  • malar flush
• Praecordium
  • inspection
  • palpation
    • apex rate greater than radial pulse
  • auscultation
    • first heart sound of variable intensity
• Lung Bases
• Ankle oedema

Investigations

• ECG
  • no P waves
  • fine oscillations of baseline
  • QRS rapid and irregular

Management

Acute

• Treat cause
• Electro-cardioversion
  • need Warfarin for 4 weeks before attempt to prevent atrial thrombus embolism

Chronic

• Control rate
  • digoxin (controls rate)
  • beta-blockers
  • diltiazem / verapamil
• Anticoagulate
  • Warfarin
  • Aspirin

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