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

History

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

Examination

  • observation
  • 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

 

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