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Atrial Fibrillation (Management (Aims of therapy are to prevent the…
Atrial Fibrillation
Management
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Beta-blocker: first line, useful in patients with thyrotoxicosis or myocardial ischemia
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Digoxin: for rate control in selected patients with atrial fibrillation, unable to tolerate β-blockers or calcium-channel blockers
Amiodarone: for conversion to and/or maintenance of sinus rhythm and for rate control in atrial fibrillation
Aspirin: indicated as thromboembolism prophylaxis in chronic paroxysmal or permanent atrial fibrillation
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(Lifestyle Modification) Coexisting disease
:red_flag: Look for and treat coexisting cardiac, pulmonary, or endocrine disease, as control of coexisting disease may reverse atrial fibrillation
:red_flag: In patients with congestive heart failure , an acute decompensation may trigger atrial fibrillation
Coexisting medication
:red_flag: Patients on medications that include catecholamines or theophylline compounds or medications that prolong the QT interval are at higher risk for developing atrial fibrillation
Investigation
ECG:The ventricular rate is typically irregular (irregular QRS complexes)
Discrete P waves are absent
FBC: looking for anemia, infection
Cardiac enzymes levels: Creatine kinase (CK) and/or troponin level, investigate myocardial infarction as a primary or secondary event)
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Serum potassium: causes of hypokalemia , such as medications, gastrointestinal loses, renal loses, and poor dietary intake, including alcoholism
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Causes & Risk Factor
hypertension, especially where left ventricular hypertrophy is present
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Clinical features
Symptoms
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Reduced exercise tolerance: lethargy, fatigue, shortness of breath on exertion
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Hx
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Ask about predisposing factors to atrial fibrillation and/or cardiac disease, such as hyperthyroidism, hypertension, hyperlipidemia, acute myocardial infarction
Signs
Pulse is irregularly irregular in rhythm, rate, and volume
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Look for evidence of hyperthyroidism—exophthalmos, goiter, tremor—although absent signs do not exclude the diagnosis
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most common type of cardiac arrhythmia, defined by irregularly irregular ventricular pulse and apical-radial mismatch
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