1 / 21

Atrial Fibrillation

Atrial Fibrillation. Outline. Epidemiology Signs and Symptoms Etiology Differential Diagnosis Diagnostic Tests Classification Management. Epidemiology. Most frequently diagnosed arrhythmia Affects 2.3 million people in the US Affects 1/136 people in the US

donagh
Download Presentation

Atrial Fibrillation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Atrial Fibrillation

  2. Outline • Epidemiology • Signs and Symptoms • Etiology • Differential Diagnosis • Diagnostic Tests • Classification • Management

  3. Epidemiology • Most frequently diagnosed arrhythmia • Affects 2.3 million people in the US • Affects 1/136 people in the US • Columbus population 769,360 (2009) • Would expect to see 5600 pts/year! • Incidence increases with age

  4. Signs and Symptoms • Palpitations • Weakness • Dizziness • Reduced exercise capacity • Dyspnea • Asymptomatic

  5. Etiology/Risk Factors • Structural heart disease • Chronic lung disease • Pneumonia • Hyperthyroidism • Alcohol use • Pulmonary embolism • HTN • Pericarditis Key Point MI is a very rare cause of Afib! Think twice before doing a ROMI

  6. Differential Diagnosis • Narrow Complex Tachycardias • Atrial Fibrillation • Atrial Flutter • AVNRT • AVRT • Atrial tachycardia • Sinus tachycardia • Multifocal atrial tachycardia SVT is a category, not a diagnosis!

  7. Classification • Paroxysmal: terminates in < 7 days • Persistent: fails to terminate within 7 days • Permanent: > 1 year • Lone: Individuals without structural heart disease, < 60 yrs old

  8. Diagnostic Testing: EKG Irregularly Irregular Narrow Complex Rapid Ventricular Rate

  9. Diagnostic Testing: TTE • To assess for structural heart disease • EF • Wall motion • Dilation/Hypertrophy • Size of right and left atrium • Valvular disease • Pericardial disease

  10. Chest X-Ray • Look for emphasema/COPD • Cardiac borders • Pneumonia Rush Center for Congenital and Structural Heart Disease

  11. Management • Rate Control • Rhythm Control • Anticoagulation • Unstable patients

  12. Rate Control • Why is rate control important? • Ischemia, MI, hypotension can occur • Long term: Cardiomyopathy • Goals • Rest HR < 80 bpm • 24 Hour (Tele/Holter) < 100 bpm average • HR < 110 in 6 minute walk Key Point

  13. Rate Control (con’t) • Medications • Metoprolol / Esmolol: IV or Oral • Diltiazem: IV or Oral • Verapamil: Oral Only • Digoxin: Patients with hypotension • Amiodarone: Also for rhythm control

  14. Rhythm Control • Indications • Symptoms of a-fib persistent • To avoid long term anticoagulation • Bleeding risk • Personal preferenance

  15. Rhythm Control (con’t) • Synchronized DC cardioversion • Emergencies/Hemodynamic instability • Greater efficacy than medications • Pharmacologic cardioversion • If AF < 7days – dofetilide, flecainide, ibutilide, propaferone or amiodarone • If AF > 7 day – dofetilide or amiodarone

  16. Rate or Rhythm Control? • Affirm Study: Rate versus rhythm control • No difference in incidence of stroke • Trend towards lower mortality in the rate control group • See article • This is STILL a controversial topic!

  17. Anticoagulation and Cardioversion • Afib < 48 hours: • Cardioversion (CV) • No anticoagulation indicated • Afib > 48 hours: • Anticoagulate for 3-4 weeks before CV • OR get TEE • Anticoagulate for 1 month after CV

  18. Anticoagulation – Long Term • Risk of CVA determined by CHADS2 score (CHF, HTN, >75, DM, Previous CVA x 2) Key Points Most patients, can wait 48 hours before starting 0-1 probably don’t need anticoagulation 5-6 should be bridged with heparin/LMWH

  19. Management – Unstable Key Point Unstable: A-fib associated with Hypotension Synchronized electric Cardioversion immediately

  20. Key Points • MI is a rare CAUSE of a-fib • Rate control must be achieved during exercise, not just at rest • Not every patients needs to bridge with heparin • Unstable patients should immediately be cardioverted

  21. Questions?

More Related