| ID | 74 |
|---|---|
| Name | ATRIAL FIBRILLATION |
| Cause | Causes: 1. Mitral valve disease- commonest cause (in young and middle aged patient). 2. Acute or chronic ischaemic heart disease. 3. Systemic hypertension 4. Thyrotoxicosis 5. Subacute bacterial endocarditis 6. Pericarditis 7. Atrial septal defect 8. After thoracic operation 9. Alcohol drink 10. Cardiomyopathy 11. Pulmonary embolism 12. Pneumonia B.Idiopathic |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigations: 1. X-ray chest P/A view 2. ECG (special) |
| Management | |
| Introduction | In this type of arrhythmia, the atria beat rapidly, chaotically and ineffectively and ventricles respond at irregular intervals. So, pulse rhythm is irregularly irregular & average rate is about 100-180/minute. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: 1. May be asymptomatic- commonly in the elderly. 2 Palpitation and exertional dyspnoea. 3. Pulse- irregularly irregular, average rate 100-180/minute; ‘pulse deficit’ may be present. 4. ECGfindings- - absence of P wave - no change in QRS complex - the baseline shows irregular fibrillation waves. |
| Preventions | |
| Treatment | Treatment: 1. Digitalisation is the treatment of choice, may be combined (if necessary) with diuretics and oxygen. 2. Digoxin dose should be continued at a rate that the ventricular beats can be maintained in between 70-80/minute. Atrial fibrillation due to thyrotoxicosis is usually nonresponsive to digoxin therapy, in that case b-blockers may be better to be used. 3. Elective DC cardioversion- if fibrillation persists after correction of thyrotoxicosis. 4. Flecanide (if digoxin is not effective) 2mg/kg in i.v infusion may be given. 5. Warfarin- as longterm anticoagulant therapy to reduce the risk of systemic embolism. 6. Treatment of underlying causes (e.g thyrotoxicosis, post-operative chest infection, pneumonia etc). |
| Complications | Complications: 1. Cardiac failure 2. Pulmonary oedema 3. Stasis, thrombosis and then systemic thrombo-embolism. |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology |
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