Arrythmias

Arrythmias

Atrial Fibrillation
1. common (5-10% of 65+)
2. 300-600/min atria contraction
3. causes: any condit resulting in increased atrial pressure, increased atrial musc mass, atrial fibrosis, inflamm + infiltration of atrium
  1. most common: HYPERTENSION, HEART FAILURE
  2. also: rheumatic heart disease, alcohol intoxication, thyrotoxicosis
  3. family linked. may be idopathic. many after CABG or valv surg
4. symps
  1. variable, maybe palps
5. signs
  1. irregularly irreg pulse
6. investig
  1. ECG
    1. fine oscilations of baseline w/no clear P waves. QRS rythym rapid + irregularly irreg. Ventric rate 120-180, but slows w/treatment
7. management
  1. treat provoking cause (eg alch toxicity, hyperthyroid, chest infect)
  2. acute manage- ventricular rate control (drugs which block av node) or cardioversion (electircally or medically)
  3. + Anticoags (to decrease stroke risk)
    1. if have risk factors
      1. 1 major (protehtic valve, rheumatic mitral valve disease, prior CVA/TIA)
      2. or 2 minor: 75+, CCF, hypertens, DM
      3. other risks: age 65-74, CAD, hx of thyrotoxicosis, F, LA enlarge, LV dysfunct, atrial thrombus or reduced atrial appendage emptying
    2. warfarin if hi risk, aspirin if medium
  4. rhym control for younger symptomatic + physically active pts
  5. rate control for perm form of arrhythmia w/symps OR 65+
    1. digoxin, B-blockers, or CCBs
recog on ECG
1. sinus rythum
2. AF
3. tachycardias
  1. narrow
  2. broad complex
4. pulseless electrial activity
  1. dead
  2. looks just like sinus rhythm, but no pulse
5. asystole
6. degrees of AV block
  1. 1- increased PR interval
  2. 2. 1st degree- wenckebach - progressively longer PRs until drop, then repeat
    1. 2nd degree: 2:1 or 3:1 block, not progressive
  3. 3. complete heart block, Ps and qrs have no relat to each other
7. acute/previous MI

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