Patients may have difficulty tolerating the beta blocker side effects, such as fatigue, and there is a potential risk of excessive bradycardia. As with other class III antiarrhythmic agents, sotalol causes QT prolongation and may result in ventricular proarrhythmia, such as torsades de pointes.
Signs and symptoms Normal rhythm tracing top Atrial fibrillation bottom AF is usually accompanied by symptoms related to a rapid heart rate. Rapid and irregular heart rates may be perceived as palpitations or exercise intolerance and occasionally may produce anginal chest pain if the high heart rate causes ischemia.
Other possible symptoms include congestive symptoms such Atrial fibrillation case study shortness of breath or swelling. The arrhythmia is sometimes only identified with the onset of a stroke or a transient ischemic attack TIA. It is not uncommon for a person to first become aware of AF from a routine physical examination or ECGas it often does not cause symptoms.
A history of stroke or TIA, as well as high blood pressurediabetesheart failureor rheumatic fever may indicate whether someone with AF is at a higher risk of complications. Rapid heart rate Presentation is similar to other forms of rapid heart rate and may be asymptomatic.
Common symptoms of uncontrolled atrial fibrillation may include shortness of breath shortness of breath when lying flatdizziness, and sudden onset of shortness of breath during the night. This may progress to swelling of the lower extremitiesa manifestation of congestive heart failure. Due to inadequate cardiac output, individuals with AF may also complain of light-headedness may feel like they are about to faintor may actually lose consciousness.
AF can cause respiratory distress due to congestion in the lungs. By definition, the heart rate will be greater than beats per minute. Blood pressure may be variable, and often difficult to measure as the beat-by-beat variability causes problems for most digital oscillometric non-invasive blood pressure monitors.
For this reason, when determining heart rate in AF, direct cardiac auscultation is recommended. Low blood pressure is most concerning and a sign that immediate treatment is required. Many of the symptoms associated with uncontrolled atrial fibrillation are a manifestation of congestive heart failure due to the reduced cardiac output.
Respiratory rate will be increased in the presence of respiratory distress. Pulse oximetry may confirm the presence of hypoxia related to any precipitating factors such as pneumonia.
Examination of the jugular veins may reveal elevated pressure jugular venous distention. Lung exam may reveal crackles, which are suggestive of pulmonary edema. Heart exam will reveal a rapid irregular rhythm. Causes AF is linked to several forms of cardiovascular disease, but may occur in otherwise normal hearts.
Cardiovascular factors known to be associated with the development of AF include high blood pressurecoronary artery diseasemitral stenosis e.
Additionally, lung diseases such as pneumonialung cancerpulmonary embolismand sarcoidosis are thought to play a role in certain people.
A study of more than 2, people found an increased risk factor for AF of 1. When the myocardium is stimulated, it contracts. It is the ordered stimulation of the myocardium that allows efficient contraction of the heart, thereby allowing blood to be pumped to the body.Case Studies Jonathan S.
Steinberg, MD. Case Studies: Atrial Fibrillation Jonathan S. Steinberg Valley Health System. Columbia University. New York, NY and Ridgewood, NJ. CASE #1.
Patient Background • Initial consultation – 62 yo male – 15 yr h/o recurrent palps x hrs. Definition.
Atrial fibrillation (AF) is a common heart rhythm disorder caused by degeneration of the electrical impulses in the upper cardiac chambers (atria) resulting in a change from an organized heart rhythm to a rapid, chaotic rhythm.
The most common cardiac arrhythmia, atrial fibrillation, occurs when the normal electrical impulses that are generated by the SA node are overwhelmed by disorganized electrical impulses in the atria.
These disorganized impulses cause the muscles of the upper chambers of the heart to quiver (fibrillate) and this leads to the conduction of .
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Atrial fibrillation is a leading preventable cause of recurrent stroke for which early detection and treatment are critical.
However, paroxysmal atrial fibrillation is often asymptomatic and. The management of atrial fibrillation (AF) is focused on preventing temporary circulatory instability and to prevent stroke and other ischemic events. Control of heart rate and rhythm are principally used to achieve the former, while anticoagulation may be employed to decrease the risk of stroke.
Within the context of stroke, the discipline may be referred to as stroke prevention in atrial.