atrial fibrillation good

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recent updates about diagnosis and management of atrial fibrillation

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  • 1. Atrial fibrillation Diagnosis and Management Dr K V pradeep babu. Post graduate , Internal Medicine, PSIMS &RF

2. Clinical features of AF 3. It is estimated that approximately 25% of patients with AF are asymptomatic Among those that are, symptoms associated with AF are variable. Typical symptoms include palpitations, tachycardia, fatigue, weakness, dizziness, lightheadedness, reduced exercise capacity, increased urination, or mild dyspnea. The history should focus on obtaining the following information: A description of the symptoms: onset or date of discovery, the frequency and duration, severity, and qualitative characteristics. 4. More severe symptoms include dyspnea at rest, angina, presyncope, or infrequently, syncope. In addition, some patients present with an embolic event or the insidious onset of rightsided heart failure (as manifested by peripheral edema, weight gain, and ascites). Precipitating causes: exercise, emotion, or alcohol. Polyuria can occur because of release of atrial natriuretic hormone. 5. Syncope is an uncommon symptom of AF, most often caused bya long sinus pause on termination of AF in a patient with the sick sinus syndrome. Less commonly, syncope occurs with a rapid ventricular rate either because of neurocardiogenic (vasodepressor) syncope that is triggered by the tachycardia a severe drop in blood pressure due to a sudden reduction in cardiac output, mostly in AS, HOCM. 6. The presence of the following disease associations should be noted : cardiovascular or cerebrovascular disease Diabetes Hypertension Chronic obstructive pulmonary disease potentially reversible causes (eg, hyperthyroidism, excessive alcohol ingestion). 7. Clinical findings in AF The hallmark of AF on physical examination is an irregularly irregular pulse. Short R-R intervals during AF do not allow adequate time for left ventricular diastolic filling, resulting in a low stroke volume and the absence of palpable peripheral pulse. This results in a pulse deficit, during which the peripheral pulse is not as rapid as the apical rate. Other manifestations of AF on the physical examination are irregular jugular venous pulsations and variable intensity of the first heart sound. 8. Clinical Evaluation of Atrial Fibrillation 9. Minimum Evaluation : 10. The electrocardiogram in atrial fibrillation 11. Findings on ECG Lack of discrete P waves. Fibrillatory or f waves are present at a rate that is generally between 350 and 600 beats/minute the f waves vary continuously in amplitude, morphology, and intervals. The variability in the intervals between QRS complexes is often termed irregularly irregular. 12. The ventricular rate usually ranges between 90 to 170 beats/min. The QRS complexes are narrow unless AV conduction through the His Purkinje system is abnormal due to Functional (rate-related) aberration Pre-existing bundle branch or fascicular block ventricular preexcitation with conduction down the accessory pathway. 13. AF is associated with the following changes on ECGAF with f waves 14. AF without f waves 15. ATRIAL ACTIVITY in AF In AF there is no regular or organized atrial activity Numerous micro-reentrant circuits within the atria generate multiple waves of impulses which often compete with or even extinguish each other. No uniform activation of the atrial tissue and no distinctive P waves are generated or recognized on the surface ECG. The sinus node is suppressed or not able to be expressed . 16. F waves When the AF is of recent onset, the f waves are often coarse (>2 mm). Coarse AF in which the amplitude of the f waves is large (especially in lead V1) is more common in recent onset AF and can be confused with atrial flutter or multifocal atrial tachycardia. The f waves are usually fine (