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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
- Vascular
- Neoplastic
- Metabolic
- Idiopathic
- Drugs
- Trauma
- Congenital / Genetic
History
- palpitations
- deterioration of well-being / exercise tolerance
- worsening of Heart Failure
Examination
- observation
- Hands
- Pulse
- irregularly irregular pulse
- volume irregular
- BP
- Neck
- goitre of hyperthyroidism
- Face
- 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
- Anticoagulate
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