New Onset Atrial Fibrillation Part 1

Atrial Fibrillation with rapid ventricular response

Mnemonic for Treating New Onset Atrial Fibrillation

Primary Survey

Review history

Obtain 12 lead EKG

Verify Date of Onset

Intervention goals

Drugs and/or direct cardioversion

Emboli

Primary Survey

©      Airway- supplemental oxygen

©      Breathing

©      Circulation

©      Check VS

©      Assess pulse

©      Attach defibrillator/monitor

©      12 lead EKG

©      IV access

Note

Because hypoxemia is a common cause of tachycardia, initial evaluation of any patient with tachycardia should focus on signs of increased work of breathing (tachypnea, intercostal retractions, suprasternal retractions, paradoxical abdominal breathing) and oxyhemoglobin saturation as determined by pulse oximetry

Review History

©      Symptoms associated with AF

©      Clinical type of AF (first episode, paroxysmal, persistent, or permanent)

©      Onset of the first symptomatic attack or date of discovery of AF

©      Precipitating factors

©      Presence of any underlying heart disease or other reversible conditions (e.g., hyperthyroidism or alcohol consumption)

Symptoms associated with AF

©      Evaluate the patient: symptomatic or unstable

©      Identify potential reversible causes of the tachycardia

Note:

Many experts suggest that when a heart rate is <150 beats per minute, it is unlikely that symptoms of instability are caused primarily by the tachycardia unless there is impaired ventricular function.

Symptomatic Tachycardia

©      Symptomatic implies that an arrhythmia is causing symptoms, such as palpitations, lightheadedness, or dyspnea, but the patient is stable and not in imminent danger.

©      In such cases more time is available to decide on the most appropriate intervention

Unstable Tachycardia

©      Refers to a condition in which vital organ function is acutely impaired or cardiac arrest is ongoing or imminent.

©      When an arrhythmia causes a patient to be unstable, immediate intervention is indicated

©       

Symptoms of Instability

©      Chest pain

©      Syncope

©      Shortness of breath

©      Cold and clammy skin

©      Decreased level of consciousness

©      Hypotension

©      Pulmonary congestion

Clinical types of AF

©      Primary AF applies to episodes lasting more than 30 seconds without a reversible cause.

©      Recurrent AF:   Patient has 2 or more episodes

©      Paroxysmal:  when the arrhythmia terminates spontaneously

©      Persistent:  when sustained beyond 7 days, also includes cases of long-standing

©      Long-standing: >1 year

©      Permanent:  in which cardioversion has failed or has been foregone.

©      Secondary AF in the setting of acute myocardial infarction (MI), cardiac surgery, pericarditis, myocarditis, hyperthyroidism, or acute pulmonary disease

©      Lone AF applies to individuals under 60 years old without clinical or echocardiographic evidence of cardiopulmonary disease, including hypertension.

©      Nonvalvular AF refers to cases without rheumatic mitral valve disease, prosthetic heart valve or valve repair.