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Atrial fibrillation

• Fibrillation
  • Muscular twitching involving individual muscle fibers acting WITHOUT coordination
• The most common chronic arrhythmia
• Onset is PSVT before becoming chronic
• First event will spontaneously convert 60% of the time within the first 24 hrs

Risk Factors

• Can occur without any risk factors
• Chronic HTN
• Coronary artery disease
• Valve disorders
• Hyperthyroid

Clinical presentation

• Routine office visit
• Palpitations
• Light headedness (Hypotension)
• Shortness of breath
• Chest pain

Physical Exam Findings

• Irregularly irregular pulse
• Heart rate more like 150–200

Labs & Studies

• Thyroid panel
• ECG is diagnostic showing irregularly irregular rhythm with no p waves and disorganized electrical activity where p waves should
• ECHO will show the fibrillating atria and irregular contractions of the ventricles

Treatment

• Medical treatment
  • Rate control
    • Beta blockers
    • Digoxin
    • Calcium channel blockers
  • Antithrombotic medications
    • Heparin (short term)
    • Lovenox (short term)
    • Warfarin (coumadin ) long term – goal of INR of 2.5
• Cardioversion
  • Electrical
  • Chemical
    • Amiodarone
    • Procainamide
• Radiofrequency ablation

Atrial Flutter

• Is more organized than atrial fibrillation
• The atria are contracting at close to 300 bpm but the AV node won’t conduct much over 180 bpm
• Flutter waves.

Clinical presentation

• Routine office visit
• Palpitations
• Light headedness (Hypotension)
• Shortness of breath
• Chest pain

Risk Factors

• Can occur without any risk factors
• Chronic HTN
• Coronary artery disease
• Valve disorders
• Hyperthyroid

Physical Exam Findings

• Regular or irregular pulse
• Heart rate 100–200 bpm
• May be hypotensive

Labs and Studies

• Thyroid panel
• Atrial rate of between 250–300
• Ventricular rate of 100–150
• ECG
  • Flutter waves at a rate of about 300 bpm
  • Ventricular rate less than 180
• Echo

Treatment

• Medical treatment
  • Rate control
    • Beta blockers
    • Digoxin
    • Calcium channel blockers
  • Antithrombotic medications
    • Heparin (short term)
    • Lovenox (short term)
    • Warfarin (coumadin ) long term – goal of INR of 2.5
• Cardioversion
  • Electrical
  • Chemical
    • Amiodarone
      -Procainamide
• Radiofrequency ablation

Sick Sinus Syndrome

• Also known as brady-tachy syndrome
• Alternating episodes of supraventricular tach and bradycardia

Risk factors

• Any cardiac history but specially history of supraventricular tachyarrhythmias
• Advancing age
• Multiple cardiac medications

Clinical presentation

• Routine office visit
• Palpitations
• Light headedness (Hypotension)
• Shortness of breath
• Chest pain

Treatment

• Implanted pacemaker

Study Tip

• Spend time training your brain for the grueling five hours of focus ahead.