...Introduction For the purpose of this assignment I have chosen to review a client with atrial fibrillation in a primary care setting. I will discuss the patient’s original presentation, including analysis and interpretation of his 12 lead electrocardiogram (ECG), diagnosis and subsequent management. Throughout the assignment I will discuss local and national guidelines and the evidence behind the chosen management for this client. For the purpose of this assignment the client will be referred to as Mr. Jones. Cardiac arrhythmias affect more than 700,000 people in England is one of the top ten reasons for hospital admission (Department of Health 2005). Atrial fibrillation (AF) is the most common and important cardiac arrhythmia, it the most common of all the arrhythmias seen in general practice. AF affects 5% of the UK population over the age of 65 years, rising to 10% in those over 75 years of age (Kirby 2005). The principal significance, both to the patient and the healthcare system is the increased risk of embolic stroke. Atrial fibrillation is associated with 15% of all strokes and with 36% of strokes in patients over the age of 60 (Hobbs 1999). Having a diagnosis of AF increases the risk of stroke five fold. It is an arrhythmia associated with serious morbidity, mortality and health service utilisation. AF and its complications now consume 1% of the United Kingdom National Health Service budget (Watson, Shanstila, and Lip 2007). Despite this it is an area that frequently...
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...Atrial Fibrillation Pathophysiology March 20, 2016 Introduction Atrial Fibrillation, commonly known as A-Fib or AF, is the most common type of persistent cardiac arrhythmia. AF effects only 2% of the population under the age of 65, but 9% of those over the age of 65 (Centers for Disease Control and Prevention [CDC], 2015). Many other cardiac diseases are seen with AF, either as a cause, or as a result of the atrial fibrillation. Left untreated, AF can result in tachycardia that causes ventricular dysfunction and/or heart failure, along with a significantly increased risk of thromboembolic stroke. I recently conducted an interview with my father who has had AF for nearly 20 years and I compared my findings in the literature against his experiences with the disease. Pathophysiology Atrial Fibrillation is a supraventricular tachyarrthymia. In the heart, ventricular rate is controlled by the conduction and refractory properties of the AV node and the progression of wave fronts entering the AV node. Calcium channels are accountable for the major depolarizing current in AV nodal cells. Beta-adrenergic receptor stimulation boosts AV nodal conduction, whereas vagal stimulation impedes AV nodal conduction. Sympathetic activation and vagal withdrawal, as with illness or exertion, speeds up the ventricular rate. After each atrial excitation wave that depolarizes AV nodal tissue, those cells become refractory for a time, preventing subsequent impulses from propagating...
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...Atrial fibrillation is a heart condition which can cause an abnormally fast and irregular heart rhythm (see appendix one). AF can be initiated when the normal impulses produced by the sinus node are overwhelmed by rapid electrical discharges from the atria and neighbouring parts of the pulmonary veins (Klabunde, 2005). Episodes of AF are not always accompanied by symptoms, however chest pains, palpitations and shortness of breath can occur sporadically. The exact causes of AF can be debated, however it may be more common in specific groups of people. People suffering with hypertension, atherosclerosis and heart valve disease may be more prone to experiencing AF (NHS, 2013). Genetics may also be a growing factor in the pathogenesis of AF (Hong and Xiong, 2014). Studies have shown that 30% of individuals with atrial fibrillation had parents with atrial fibrillation (Fox, 2004). Treatments for AF may differentiate between individuals due to factors such as age, overall health and type of AF. Cardiologists may first try to discard the possibility of any underlying triggers for AF, such as hyperthyroidism. The main risk factor for AF sufferers can be increased chance of strokes occurring, therefore treatments may usually include anticoagulant medicines such as warfarin. Cardioversion (electric...
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...Atrial fibrillation (AF) is a heart arrhythmia that affects both the atria and the ventricles of the heart. It is characterized by an irregularly irregular heart rate. The atria are beating rapidly and irregularly, and the ventricles are beating typically fast and irregularly, but out of sync with the atria. There are several classifications for AF. Recurrent AF is defined as two or more episodes of AF. More commonly, paroxysmal AF can last up to seven days, but spontaneously resolves. If it doesn’t spontaneously resolve and persists for more than seven days it is called persistent AF. Similarly, if AF cannot be resolved in more than seven days, it is termed permanent AF. On the other hand, if AF is the only indicator of a disease associated with the heart, it is called Lone AF. AF is the most common heart...
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...Atrial Fibrillation And Nursing Considerations As a nurse one must provide holistic care. To better understand aspect of providing holistic nursing care one must have an in-depth understanding of primary body systems and their pathology. This paper will educate the prudent nurses who read it with detailed information about the specific cardiac pathology of atrial fibrillation. Written with a basic understanding of human heart function/structure as a prerequisite, this paper will first discuss key terms one must be familiar with before providing researched information explaining the pathophysiology of atrial fibrillation (AF). Next, it will discuss the etiology, clinical manifestations, common laboratory diagnostics, and interventions. Lastly, this paper continues by providing readers with nursing diagnoses and patient teachings associated with AF. Key Terms As a nurse one must become a scientist of sorts and must be familiar with technical nursing terminology. Atrial fibrillation, or AF, is a cardiac dysrhythmia in which “multiple rapid impulses from many atrial foci depolarize the atria in a totally disorganized manner at a rate of 350 to 600 times per minute” [ (Ignatavicius & Workman, 2010) ]. A dysrhythmia is a disorder of the heartbeat involving a disturbance in cardiac rhythm and an irregular heartbeat; whereas an arrhythmia is basically a fast or irregular heartbeat caused by a disorder in the heart's electrical system. Tachydysrhythmia is an abnormal...
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...European Journal of Echocardiography (2011) 12, 421–430 doi:10.1093/ejechocard/jeq175 REVIEW Left atrial function: physiology, assessment, and clinical implications Gustavo G. Blume 1, Christopher J. Mcleod 1, Marion E. Barnes 2, James B. Seward 1, Patricia A. Pellikka 1, Paul M. Bastiansen 1, and Teresa S.M. Tsang 2* 1 Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA; and 2Division of Cardiology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, Canada Online publish-ahead-of-print 12 May 2011 The interest in the left atrium (LA) has resurged over the recent years. In the early 1980s, multiple studies were conducted to determine the normal values of LA size. Over the past decade, LA size as an imaging biomarker has been consistently shown to be a powerful predictor of outcomes, including major public health problems such as atrial fibrillation, heart failure, stroke, and death. More recently, functional assessment of the LA has been shown to be, at least as, if not more robust, a marker of cardiovascular outcomes. Current available data suggest that the combined evaluation of LA size and LA function will augment prognostication. The aim of this review is to provide a critical appraisal of current echocardiographic techniques for the assessment of LA function and the implications of such assessment for prediction and disease prevention. ------------------------------------------------------------------...
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...Stroke prevention with aspirin, warfarin and ximelagatran in patients with non-valvular atrial fibrillation: a systematic review and meta-analysis. Lip GY, Edwards SJ. Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, UK. g.y.h.lip@bham.ac.uk Abstract OBJECTIVE: To compare the effectiveness of aspirin, warfarin, and ximelagatran as thromboprophylaxis in patients with non-valvular atrial fibrillation (NVAF). METHODS: Systematic review of randomised controlled trials in patients with NVAF treated with adjusted-dose warfarin and aspirin, fixed low-dose (FLD) warfarin, ximelagatran or placebo. Outcome measures studied were ischaemic stroke, systemic embolism, mortality and haemorrhage. Meta-analysis was performed using a fixed effects model. RESULTS: We identified 13 trials (n=14,423 participants) of sufficient quality to be included in the analysis. Adjusted-dose warfarin significantly reduced the risk of ischaemic stroke or systemic embolism compared with aspirin (relative risk [RR] 0.59; 95% confidence interval [CI]: 0.40 to 0.86), FLD warfarin (RR 0.36; 95% CI: 0.23 to 0.58), or placebo (RR 0.33; 95% CI: 0.24 to 0.45). However, aspirin and placebo had a lower risk of major bleeding compared to warfarin (RR 0.58; 95% CI: 0.35 to 0.97 and RR 0.45; 95% CI: 0.25 to 0.82, respectively). The oral direct thrombin inhibitor, ximelagatran was as effective as adjusted-dose warfarin in the prevention of ischaemic strokes...
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...the occupational therapist and also accompany her during a home visit. A few of the health conditions that I came across that benefit from occupational therapy include limitations following a stroke or heart attack, arthritis, multiple sclerosis, or other serious chronic conditions, spinal cord injuries, or amputations, broken bones or other injuries from falls. Occupational therapists provide a service that is customized to improve a person's ability to perform daily activities. Occupational therapists use a variety of interventions including biofeedback, relaxation, goal setting, problem solving, planning in order to rehabilitate patients. During the home visit we visited an 87year-old gentleman with a history of falls, cardiac failure, atrial fibrillation and dementia. The patient felt dizzy when he stood up and at one point burned himself while standing next to the radiator and did not notice the injury, he also struggled to carry out activities of daily living like getting in and out of the bath, in and out of bed and going up the stairs. The occupational therapist played a fundamental role to ensure safety of this patient. The patient was offered a hand rail in the bath to help when standing up, rails along the stairs so he could hold on to when going up and down the stairs. A stool to sit on while in the bath, a mat to prevent slipping. She also offered the patient to raise his arm chair in order to make it easy to stand up and also raise the bed to make it easier so get...
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...you expect to see? How would the symptoms be different if the hole was located between the right and left ventricles? Blood from the body will enter the heart through vena cava to the right atria through the tricuspid valve into the right ventricle and to the lungs. This blood is deoxygenated or it lack oxygen. In the lungs, carbon dioxide will be removed and replaced by oxygen in the process called oxygenation. Then oxygenated blood will flow out of the lungs via pulmonary vein to the left atria, to the left ventricles and to the body via Aorta. Left and right atria are separated by the septum. When there is a “hole” between right and left atrium, blood will flow from left to right atrium instead of flowing to the body. This is called atrial septal defect (ASD). According to American Heart Association (AHA), “this defect allows oxygen-rich blood to leak into the oxygen-poor blood chambers in the heart”, hence reducing oxygen circulating in the body. When there is less oxygen in the body, the patient will have the following symptoms; dizziness, shortness of breath, lung problems including pneumonia, and change in heart and lung sounds due to accumulation of blood in the heart. If there is a “hole between right and left ventricles, the blood will be flowing from left to right ventricles due to high pressure on the left ventricle compared to that of the right. There will be less blood flowing to systemic circulation and most of oxygenated blood will be within the pulmonic circulations...
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...COVER ARTICLE PRACTICAL THERAPEUTICS Acute Management of Atrial Fibrillation: Part I. Rate and Rhythm Control DANA E. KING, M.D., LORI M. DICKERSON, PHARM.D., and JONATHAN L. SACK, M.D. Medical University of South Carolina, Charleston, South Carolina Atrial fibrillation is the arrhythmia most commonly encountered in family practice. Serious complications can include congestive heart failure, myocardial infarction, and thromboembolism. Initial treatment is directed at controlling the ventricular rate, most often with a calcium channel blocker, a beta blocker, or digoxin. Medical or electrical cardioversion to restore sinus rhythm is the next step in patients who remain in atrial fibrillation. Heparin should be administered to hospitalized patients undergoing medical or electrical cardioversion. Anticoagulation with warfarin should be used for three weeks before elective cardioversion and continued for four weeks after cardioversion. The recommendations provided in this two-part article are consistent with guidelines published by the American Heart Association and the Agency for Healthcare Research and Quality. (Am Fam Physician 2002;66:249-56. Copyright© 2002 American Academy of Family Physicians.) I Members of various family practice departments develop articles for “Practical Therapeutics.” This article is one in a series coordinated by the Department of Family Medicine at the Medical University of South Carolina. Guest editor of the series is ...
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...Atrial Fibrillation Seminar Case 1 CC: “My chest seems to be pounding fast and it will not go away” HPI: MJ is a 66-year-old Caucasian male who presents to his PCP because of increased chest palpitations. The patient stated that he started feeling chest palpitations about 2 weeks ago. At first he barely noticed them and attributed them to some bad heartburn from eating too much spicy food. However, the palpitations have become progressively more prominent over the last 4-5 days and therefore the patient thought he should visit the doctor. The patient states that he has had no recent medication changes and has been on the same medication regimen for about 2-3 years now. The patient also stated that he felt similar chest pounding about 4 months ago but it seemed to go away really quick and decided he did not need to do anything about it. PMH: Meds: DM Type 2 ASA 81 mg PO daily HF (LVEF ~35%) (13 years ago) Furosemide 20 mg PO daily HTN KCL 10 mEq PO daily s/p MI (16 years ago) Lisinopril 20 mg PO daily Hypercholesterolemia Atorvastatin 40 mg PO daily Gout Metoprolol succinate XL 25 mg PO daily Glipizide XL 20 mg PO daily Allopurinol 150 mg PO daily Allergies: NKDA SH: Lives with wife; employed as a construction foreman; quit drinking alcohol after HF diagnosis; quit tobacco after MI; tries to stay active and does moderate exercise at the gym at least 3 times/week. Plays golf every other weekend. FH: non-contributory Today’s...
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...think of the strips ? • Is there any “strange behavior” of the pacemaker ? strange behavior • What are the two Different diagnosis for the two strips ? • Th h ld , sensing and i Thresholds i d impedances are all within normal d ll ithi l ranges Think and …. Answer to The first rhythm – is it PMT? 1 2 3 4 5 6 7 8 VA conduction test performed in clinic by pacing V VA during testing is indeed very similar to VA in tachycardia: PMT most likely explanation OK so it is PMT what happened after 8 b t ? i h th d ft beats PMT termination algorithm attempted to terminate the tachycardia 1 2 3 4 5 6 7 8 PVARP EXTENSION TO 400MS Why didn’t it terminate the tachycardia ? NCAP Interval of I t l f 300ms Atrial pacing without capture due To atrial refractoriness resulting in Triggerring of PMT again Ongoing PMT Now that we believe that...
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...(Figueroa & Peters, 2006). 2. Digoxin toxicity, Digoxin toxicity is caused by high levels of digoxin in the body a drug Mr Marshall is currently prescribed. His digoxin levels are 2.4 ng/mL and the therapeutic range is 0.6 to 1.3 ng/mL showing increased levels beyond the therapeutic range (Chan, Bradley & Harrigan, 2002). Mr Marshall’s irregular pulse as well as his nausea and vomiting are clinical symptoms of digoxin toxicity (Ehle, Patel, Chandni & Giugliano, 2011). Question 1.2 Explain why Mr Marshall is prescribed the following medications in relation to his past medical history. Include in your response the related medical condition, drug action and category. Digoxin; this medication is prescribed to Mr Marshall to treat atrial fibralation a past condition of the patient....
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...Ques 1. What is Neostigmine? Discuss why this drug may have been given to Mrs. Lim. Include drug action and desired effects, adverse drug reaction(s), drug interactions, appropriate dosage and rationale for use. Ans 1. Neostigmine is a drug which belongs to the family of medicines called as the anticholinesterases (neostigmine). This drug works by inhibiting the action of the enzyme acetylcholinesterase, which in turn leads to a prolonged action of the enzyme acetylcholine. Acetylcholine stimulates the muscarinic receptors present in the muscles, thus causing muscle contraction. Vecuronium, given to Mrs. Lim is a neuromuscular blocking agent. To subside its effect, she was given Neostigmine, which also improves the respiratory function (Brodie & Axelrod, 2009). Neostigmine produces an antagonistic effect to Vecuronium. After Vercuronium, a dose of 2.5mg or 5mg Neostigmine is sufficient to produce a muscle twitch of about 90%. It also leads to increased cardiovascular effect (Caldwell,J., 1995). The drug is required to cause muscle contraction opposite to the muscle relaxation, as was caused by the dose of anaesthesia. Some of the common side effects associated with the drug use are nausea, vomiting, diarrhoea, stomach cramps, involuntary urination, faintness, muscle cramps or twitching. These symptoms however, due not require any medical treatment. Some other severe problems associated with this drug are slow heart rate, shortness of breath, severe rashes, irritation...
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...In a world of health and technology, there are always new innovations and techniques coming out that are built to help us as a human race live on and grow. One of these prime examples is a contribution from an unlikely source, Xerox. Xerox is developing an innovative and easier way to detect and monitor the most common type of arrhythmia using a basic webcam (Pogorelc, D. 2014, September 3). Xerox has built a software algorithm that can analyze the skin of the face looking for subtle color change, which can be associated and indicate irregular blood flow caused by atrial fibrillation (Pogorelc, D. 2014, September 3). In the United States atrial fibrillation affects nearly three million Americans, which is the occurrence of the upper and lower chambers (the atriums and ventricles) out of sync each time the heart beats (Pogorelc, D. 2014, September 3). Atrial fibrillation is not one of those conditions that are difficult to diagnose, it is readily diagnosed and treated, but it often can go undetected because of the symptoms being too general and they can come and go (Pogorelc, D. 2014, September 3). There are three types of AFib: 1. Paroxysmal fibrillation - is when the heart returns to a normal rhythm on its own within 7 days of its start, 2. Persistent AFib- an irregular rhythm that lasts for longer than 7 days, which will require some form of treatment, 3. Permanent AFib occurs when the condition lasts indefinitely (What are the Symptoms, 2016, April 14). Leaving AFib untreated...
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