A patient who is admitted through the E.R. with an initial diagnosis arterial fibrillation:
a- slow ventricular response using verapamil
b- start lidocaine infusion
c- considered anticoagulation with warfarine
d- a and c
e- e- b and c
------------------------
What is atrial fibrillation?
When the normal (sinus) heart rhythm is lost, arrhythmia occurs. Atrial fibrillation (AF) is the most frequent arrhythmia and occurs when in normal conditions:
- Heart rate rises or falls. Heart rate is the rate at which the heart beats; that is, it is the number of times it contracts per minute. Normally, the frequency is between 60 and 100 beats per minute. Arrhythmia occurs when, under normal conditions, the heart rate drops (brachycardia) or rises (tachycardia).
- The heart rate is no longer regular. Heart rate refers to how heartbeats occur; if they are regular or irregular. The heart rate adapts to the needs of the body at all times. That's why it speeds up when you exercise and slows down when we sleep. But, under normal conditions, it must be regular.
Causes of atrial fibrillation
Occasionally, atrial fibrillation appears for no apparent reason, but other times there is a clear trigger. These are the most common causes:
- Hypertension The most common cause of atrial fibrillation is high blood pressure or high blood pressure.
- Heart problems. Any disease in the heart (valves, angina, heart attack ...) can cause atrial fibrillation.
- Hormonal diseases. In some cases it can be the result of thyroid disorders or other hormonal diseases.
- Unknown. When no cause is found after performing the necessary tests, atrial fibrillation is called idiopathic atrial fibrillation or of unknown cause. It represents up to a third of the people affected.
Types of atrial fibrillation:
Not all people have the same number of atrial fibrillation crises, nor do they occur in the same situations. There are those who have several a month and who suffer only one episode in their life. Even so, depending on their behavior and evolution, two types of atrial fibrillation are distinguished:
- Paroxysmal. Crises appear and disappear. They are of variable duration (less than a minute to days). It is possible for paroxysmal atrial fibrillation to progress to permanent.
- Persistent and permanent. Atrial fibrillation is constant, without the normal (sinus) heart rate reappearing at any time.
How to face an atrial fibrillation crisis:
Atrial fibrillation does not always cause symptoms. In fact, it is sometimes diagnosed by chance in a routine review. Even so, the most common discomforts are: palpitations (rapid and irregular heartbeat) and very marked fatigue when performing daily activities.
When an atrial fibrillation crisis occurs, the following recommendations should be followed:
- Keep calm. Although the crisis causes discomfort and anxiety, it is important to maintain serenity. The nervousness will make the discomfort even worse.
- Do not modify the treatment schedule. If it is not the first episode of atrial fibrillation that is already taken and medication is already taken to treat the disease, it is important not to change the treatment regimen, as it can cause serious side effects. Follow the strategy of "the pill in your pocket" (take two or three tablets of treatment when you notice the onset of a crisis), should only be done when you have discussed it with the doctor.
- Go to the ER. Most crises are cut in a short time, so it is likely that, without doing anything, it will improve spontaneously. Otherwise, you must go to an Emergency Department. This is especially important when there are other symptoms that may suggest a significant affectation, such as: dizziness, fainting or loss of consciousness, difficulty breathing, chest pain or prolonging the episode longer than usual (if it is not the first crisis)
a- slow ventricular response using verapamil
b- start lidocaine infusion
c- considered anticoagulation with warfarine
d- a and c
e- e- b and c
------------------------
What is atrial fibrillation?
When the normal (sinus) heart rhythm is lost, arrhythmia occurs. Atrial fibrillation (AF) is the most frequent arrhythmia and occurs when in normal conditions:
- Heart rate rises or falls. Heart rate is the rate at which the heart beats; that is, it is the number of times it contracts per minute. Normally, the frequency is between 60 and 100 beats per minute. Arrhythmia occurs when, under normal conditions, the heart rate drops (brachycardia) or rises (tachycardia).
- The heart rate is no longer regular. Heart rate refers to how heartbeats occur; if they are regular or irregular. The heart rate adapts to the needs of the body at all times. That's why it speeds up when you exercise and slows down when we sleep. But, under normal conditions, it must be regular.
Causes of atrial fibrillation
Occasionally, atrial fibrillation appears for no apparent reason, but other times there is a clear trigger. These are the most common causes:
- Hypertension The most common cause of atrial fibrillation is high blood pressure or high blood pressure.
- Heart problems. Any disease in the heart (valves, angina, heart attack ...) can cause atrial fibrillation.
- Hormonal diseases. In some cases it can be the result of thyroid disorders or other hormonal diseases.
- Unknown. When no cause is found after performing the necessary tests, atrial fibrillation is called idiopathic atrial fibrillation or of unknown cause. It represents up to a third of the people affected.
Types of atrial fibrillation:
Not all people have the same number of atrial fibrillation crises, nor do they occur in the same situations. There are those who have several a month and who suffer only one episode in their life. Even so, depending on their behavior and evolution, two types of atrial fibrillation are distinguished:
- Paroxysmal. Crises appear and disappear. They are of variable duration (less than a minute to days). It is possible for paroxysmal atrial fibrillation to progress to permanent.
- Persistent and permanent. Atrial fibrillation is constant, without the normal (sinus) heart rate reappearing at any time.
How to face an atrial fibrillation crisis:
Atrial fibrillation does not always cause symptoms. In fact, it is sometimes diagnosed by chance in a routine review. Even so, the most common discomforts are: palpitations (rapid and irregular heartbeat) and very marked fatigue when performing daily activities.
When an atrial fibrillation crisis occurs, the following recommendations should be followed:
- Keep calm. Although the crisis causes discomfort and anxiety, it is important to maintain serenity. The nervousness will make the discomfort even worse.
- Do not modify the treatment schedule. If it is not the first episode of atrial fibrillation that is already taken and medication is already taken to treat the disease, it is important not to change the treatment regimen, as it can cause serious side effects. Follow the strategy of "the pill in your pocket" (take two or three tablets of treatment when you notice the onset of a crisis), should only be done when you have discussed it with the doctor.
- Go to the ER. Most crises are cut in a short time, so it is likely that, without doing anything, it will improve spontaneously. Otherwise, you must go to an Emergency Department. This is especially important when there are other symptoms that may suggest a significant affectation, such as: dizziness, fainting or loss of consciousness, difficulty breathing, chest pain or prolonging the episode longer than usual (if it is not the first crisis)
Diagnostic methods of atrial fibrillation:
- Electrocardiogram It is the only test necessary to diagnose atrial fibrillation. With it the electrical activity of the heart is recorded and the heart rate is assessed. It is a simple and not painful test. The only drawback of the electrocardiogram is that atrial fibrillation has to occur at the time the test is performed, and that makes diagnosis difficult when discomfort is only noticed in short periods of time (few minutes or hours).
- Holter. With this test an electrocardiogram is obtained continuously for 24 or 48 hours. Thus, episodes of atrial fibrillation of short duration or that do not cause symptoms can be diagnosed. Sometimes a Holter study is also done to complete the electrocardiogram evaluation. In any case, to perform it, electrodes are placed on the patient's chest using adhesives. The electrodes are connected to a recorder that picks up the patient's heart rate during a normal day. If at that time you feel any discomfort, you should write it down on a piece of paper next to the time it happened. Thus, the doctor can assess the presence of any arrhythmia at that particular moment.
- Echocardiogram. With this exploration, painless images of the moving heart are obtained painlessly. It allows to evaluate its shape, operation and the condition of the valves. It also helps detect many of the heart diseases that can cause atrial fibrillation.
Complications of atrial fibrillation:
With proper treatment and follow-up, the prognosis of atrial fibrillation is good and uncommon complications. The main one is the embolism that derives from the accumulation of blood in the atria due to the lack of contraction of the heart. That backwater, favors the formation of clots that can leave the heart following blood circulation and obstruct any artery in the body. As a consequence, that part of the organism stops receiving blood and loses its function. When the risk of embolism is considered high, the patient should be treated with anticoagulant medications. When the risk is low, it can be treated only with aspirin (acetylsalicylic acid) or even without medication.
Recommendations to atrial fibrillation patients:
- Control blood pressure. Blood pressure is the leading cause of atrial fibrillation. For this reason, it is especially important to maintain strict control over it.
- Moderate alcohol consumption. Alcohol is a trigger for episodes of atrial fibrillation. There are even people who only present it after an abundant intake of alcohol. It is always advisable to moderate the consumption of alcoholic beverages, but if you also have another heart disease, you should consult your doctor about its consumption. Alcohol could be absolutely contraindicated.
- Reduce stimulants. Coffee, tea, cola drinks ... are stimulants capable of causing atrial fibrillation, so you should avoid or reduce their consumption.
- Quit tobacco. Tobacco is always harmful to health and in people with atrial fibrillation it is especially dangerous because it contains stimulants (such as nicotine) that can cause seizures. Quitting smoking is ideal for reducing episodes of atrial fibrillation, as well as the possibility of suffering from cardiovascular diseases (myocardial infarction, stroke ...) or non-cardiovascular diseases (different types of cancer). To overcome the addiction more easily, it is advisable to consult with the cardiologist or with the attending physician. In many health centers there are specialized smoking units that help.
- Moderate exercise. Intense and prolonged physical exercise can reduce the efficacy of atrial fibrillation treatment, as well as increase the risk of recurrence. This does not mean that a sedentary life must be adopted. Walking every day and moving is important, but you have to avoid cross-country races, great bicycle tours and sports that involve a great cardiovascular effort.
- Travel with some precautions. There is no inconvenience in traveling, especially when the episodes are controlled. Of course, when planning a trip it is important:
Take all the medication. It is convenient to calculate the total amount of tablets to be taken and take an additional box separately in case they are lost.
Control medical appointments. When the trip coincides with a medical control, it must be communicated to the hematologist in advance, to modify the planning if necessary. In addition, if it is going to be prolonged (more than a month), it is necessary to foresee that, probably, it will be necessary to carry out a control during the same.
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