(BQ) Part 2 book Pocket protocols for ultrasound presents the following contents: Arrhythmias and sudden cardiac death, cardiovacular disease in special populations, specialized testing and therapeutics. Invite you to consult.
SECTION V V Arrhythmias and Sudden Cardiac Death CHAPTER 13 13 Atrial Fibrillation and Flutter Marco Perez and Amin Al-Ahmad Department of Internal Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, CA, USA Atrial Fibrillation • Atrial fibrillation (AF) is characterized by disorganized electrical activity in the atrium leading to loss of effective atrial contraction (Figures 13.1 and 13.2) • Most common arrhythmia, affecting 1% of the United States population • Associated with an increased risk of stroke (up to 5% per person/year in the elderly) and death Classification • Paroxysmal: recurrent episodes lasting 7 days, often requiring cardioversion • Permanent: episodes lasting >1 year Other terminology used: • Lone AF: • No associated hypertension or evidence of cardiopulmonary disease • Usually applies to younger patients, with a stronger genetic link • Implies a lower risk of thromboembolism • Can be paroxysmal, persistent, or permanent • Acquired AF: not lone AF • Chronic AF: term formerly used to refer to permanent AF • Familial AF: AF that runs in families with a Mendelian pattern of inheritance Work-up of New-Onset AF • Assess for associated conditions: hypertension, heart failure, valvular disease, chronic obstructive pulmonary disease (COPD), pulmonary embolism, hypertrophic cardiomyopathy, myocardial infarction (MI), A Practical Approach to Cardiovascular Medicine, First Edition Edited by Reza Ardehali, Marco Perez, Paul Wang © 2011 Blackwell Publishing Ltd Published 2011 by Blackwell Publishing Ltd 165 166 Arrhythmias and Sudden Cardiac Death PV LA RA LV RV Figure 13.1 Disorganized electrical activity in atrial fibrillation PV, pulmonary vein Figure 13.2 Characteristic ECG hallmarks of AF: irregular rhythm and poorly defined P-waves hyperthyroidism, endocarditis, binge drinking, excessive caffeine, diabetes mellitus (DM) • Routine tests to consider: • Echo: – Consider in all patients – High yield for younger patients or undiagnosed cardiopulmonary disease • TSH: low yield (65 years old or risk factors; symptomatic patients excluded Results: No significant difference in mortality or stroke between groups Take-home message: Recommend rate control if patient is truly asymptomatic Controlling Heart Rate Target heart rate (HR) is