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ATRIAL FIBRILLATION (AF) (DIAGNOSIS (SIGNS AND SYMPTOMS (Shortness of…

- - - - Vascular reactivity
        
        A homeostatic mechcanism responsible for changes in blood pressure, heart rate and other haemodynamic parameters induced by physical or mental stimuli
        
        Humoral and cell mediated immune response
        
        Peripheral resistance is influenced by hypertension, blood viscosity, vasoconstrictors and vessle length
      - Pre-load and cardiac output increase
      - Stress on blood viscosity and velocity
      - Ciculating blood volume is regulated by renal salt and water, therefore hypertension can irrupt with irregular salt levels
    - - Heart Valves ensure one-way blood flow -Atrioventricular valves = Tirscuspid and Bicuspid
        -Smilunar Valves = aortic and pulmonary
        
        Valvar disease
        
        Regurgitation: Valve/s does not close completely, causing backflow
        
        Stenosis: Valve/s openings become narrowed or closes incorrectly, casuing irregular stroke volume
    - - Restriction in blood supply to tissues causes a shortage of oxygen and glucose needed for cellular metabolism,
        consequently resulting in death of tissue.
      - Ischemia is generally caused by blood vessel damage: -Thrombosis - Plaque rupture -Viral and bacterial infection -Disease -Embolism -Tumor -Vasculitis
      - Types of life threatening ischemia:
        -Cerebral
        -Myocardial
    - - Abnormal heart rythm
        
        Initiating triggers caused by the rapidly firing ectopic foci located in the muscular sleeves that extend from the left atrium into the proximal sections of the pulmonary veins, resulting in disorganised and rapid atrial contractions
    - - According to scientists V.Markides and R.J.Schilling, *"A region on chromosome 10 (10q22-q24) was originally identified as containing the gene responsible for AF in families in which the arrhythmia segregated as an autosomal dominant trait. However, familial AF appears to be a heterogeneous disease." *
      - Gene mutation responsible for encoding increased cardiac potassium channel function
- - - - Auscultation of chest, listening for a irregular heart rate, rhythm, valve and myocardial contractions
      - Diagnostic procedure: 12-lead Electrocardiogram (ECG)
        
        PRESENTATION
        
        12 lead ECG presentation
        
        -Irregularly irregular heart rate
        -P waves are not present due to absence of sinoatrial node fire that are caused by uncoordinated depolarisation in the atrium
        -Isoelectric base line absence
        -Disorganised depolarisation of atrial cardiomyocytes, creating atrial rates of >300
        -Common ventricular rate 110-160
        -Normal QRS complex (width=70-100 milliseconds)
        -Fibrillation waves, known as T waves, may be present ( fine = amplitude <0.5mm or coarse= amplitude >0.5mm), however it is important to note that T waves can be mislead as P waves resulting in misdiagnosis.
      - Diagnostic test on magnesium and potassium levels, low levels can cause AF (blood test necessary)
- - - - Diagnostic tool: 12 lead ECG
        
        Confirm AF with signs, symptoms and 12 lead ECG
        
        Stable ?
        
        Provide relief of patients symptoms by controlling heart rate as it acts as the predecessor in patients symptoms. Pain relief drugs should be considered also
        
        Take patient to hospital
        
        Unstable?
        
        Patient will present acute vital signs: -Heart rate = >150 -Blood pressure < 90/60mmHg -Respiratory rate <12 -Decrease level of consciousness
        
        Consider Immediate hospital transfer OR consult for immediate cardio-version (use of 200-joule synchronized shock on sedated patient) or call for backup for higher qualified clinician to deliver cardio version
        
        consider pain relief and antcogulants
        
        3 more items...
  - - - Procedures to restore normal heart rhythm
        
        Surgical procedures
        
        Catheter ablation:electrophysiologist conducts procedure by inserting a wire through a vein in the leg or arm and threaded to the pulmonary vein. Radio wave energy is sent via the wire to destroy any abnormal tissue growth (ectopic foci found in tissue growth) that is disrupting normal flow of electrical signals.
        
        The Cox Maze 3: bi-atrial incisions to interrupt the multiple wavelet reentry circuits in order to eliminate AF. This procedure has a success rate of 97-99%. However, not a standard AF removal procedure.
        
        Electrical Cardioversion: low energy shocks are given to patients heart to reverse irregularity with myocytes. Patients are sedated before receiving shocks.
  - - - Blood pooling can occur in the atrium of the heart, initially causing protein formation, creating thrombosis' in atria, breakage of thrombosis could travel to the brain of the patient resulting in a stroke.
        
        Pharmacological treatment of prevention are blood thinners. Doctor prescription medications include, warfarin, aspirin, dabigatran and heparin.
- - - - There are twice as many men who suffer from AF then women