Atrial Fibrillation

Atrial fibrillation is a relatively common cardiac arrhythmia that results in an irregular heart rhythm.
 
New onset (acute) of atrial fibrillation is present when a rapid irregular pulse occurs. This may require emergency treatment with medications to slow the heart rate.
 
Some patients will have chronic, stable atrial fibrillation that requires daily medication to modify the heart rate. Intermittent atrial fibrillation can increase the patient’s risk of stroke. In some instances, a blood clot can form inside the fibrillating atria that can be released into the general circulation (embolization). Once the clot is released from the heart, it can lodge in the cerebral circulation, and cause a stroke, or enter the lungs, and cause a pulmonary embolism.
 
Causes

•	Hypertension (most common cause)
•	Rheumatic Heart Disease
•	Coronary Artery Disease
•	Hyperthyroidism
•	Chronic Obstructive Pulmonary Disease
•	Pericarditis
•	Acute Alcohol Intoxication
•	Atrial Septal Defect (congenital heart disease)
•	Myocardial Infarction
•	Aortic Stenosis

 
Symptoms
Common symptoms of acute atrial fibrillation include shortness of breath, palpitations, faintness and fainting, and/or chest pain.
 
Diagnosis
Evaluation will include: cardiac enzymes, ECG and cardiac monitoring, CXR, echocardiogram, and thyroid profile.
 
Treatment
Treatment is aimed at “converting” the rhythm of the heart to a normal (regular and slower) rate. This may be accomplished with IV medications, or by electrical cardioversion in more emergency situations. Chronic atrial fibrillation, when it is asymptomatic, can be controlled with medications (digoxin) that slow down the heart rate.
 
Patients with atrial fibrillation should not use medications (decongestants and cold medications) that accelerate the heart rate. They should also not smoke and avoid caffeine.

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