Tachyarrhythmia: Atrial Fibrilation & Atrial Flutter

by Carlo Raj, MD

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    Continue our discussion of dysarrhythmia and conduction system diseases. Remember once again with arrhythmias we will do two different categories or two major etiological backgrounds. One would be conduction system issues, the other one was vascular. So far, under conduction system disease, we have looked at bradyarrhythmia. Our topic now will take us into tachyarrhythmias and with tachyarrhythmias, we will focus upon SVTs at first, supraventricular tachycardias above the ventricles and we will then divide this into part I and part II. In part I, we will take a look at atrial fibrillation and atrial flutter. Let us begin. Now, with afib exceedingly common rhythm especially in elder patients. So as we get older, a number of things start slowing down. In this case, things start speeding up and by that, I mean that the normal physiology as we get older, unfortunately, starts losing its effect. Maybe the kidneys will start decreasing GFR end up developing or end up accumulating more creatinine. As we get older, our ability to protect our cell membrane from free radicles starts diminishing. The ability to have proper conduction, remember for your entire life when you had this inherent pacemaker in the heart known as the SA node it continues. I mean you would expect at some point when you get older that perhaps it is not as efficient and effective as it once was. And so in elderly people while there is every possibility that atrial fibrillation might be taking place and anytime there is an afib, what you are worried about? Well, you worried about that increased turbulence within the atrium and so, therefore, may result in stasis. And with that stasis, you are worried about Virchow’s triad, one of the components of Virchow’s triad referring to formation of a clot is what...

    About the Lecture

    The lecture Tachyarrhythmia: Atrial Fibrilation & Atrial Flutter by Carlo Raj, MD is from the course Arrythmias. It contains the following chapters:

    • Pathogenesis
    • Signs & Symptoms
    • Treatment
    • Atrial Flutter

    Included Quiz Questions

    1. Acute mesenteric ischemia
    2. Splenic vein thrombosis
    3. Intestinal perforation
    4. Biliary obstruction
    5. Abdominal aortic aneurysm
    1. Heart pump dysfunction
    2. Outlet obstruction
    3. Ectopic foci
    4. Blood flow stasis
    5. Shifting of interventricular septum between beats
    1. Every p wave is followed by a QRS complex
    2. Irregularly irregular pattern
    3. P wave is wavy or obscured
    4. QRS complexes do not show up in a regular pattern
    5. QRS complexes are dissociated from p wave
    1. Hypothyroidism
    2. Diabetes mellitus
    3. Mitral stenosis
    4. Pulmonary embolus
    5. Hypertension
    1. Improve inotropic effect
    2. Rate control
    3. All are goals
    4. Thromboembolism prophylaxis
    5. Rhythm control
    1. Lidocaine (Class Ib antiarrhythmic)
    2. Warfarin
    3. Digoxin
    4. Beta blockers
    5. Aspirin
    1. Decreased dromotropy
    2. Increased inotropy
    3. Increased dromotropy
    4. Increased chronotropy
    5. Decreased inotropy
    1. CHADS2 score = 1; treat with aspirin
    2. CHADS2 score = 3; treat with aspirin
    3. CHADS2 score = 2; treat with warfarin
    4. CHADS2 score = 2; treat with aspirin
    5. CHADS2 score = 1; treat with warfarin
    1. They both have irregularly irregular rhythms
    2. They both may present with palpitations.
    3. They both may be caused by valvular dysfunctions
    4. They both require rate control.
    5. They both involve abnormal p wave morphology.
    1. Verapamil
    2. Nifedipine
    3. Propanolol
    4. Lidocaine
    5. Metoprolol
    1. Before electric cardioversion if the rhythm is sustained for greater than 48 hours.
    2. If medical cardioversion is ineffective
    3. In a patient with an INR of 1.0.
    4. If a patient has a CHADS2 score of 1.
    5. Immediately after diagnosis.

    Author of lecture Tachyarrhythmia: Atrial Fibrilation & Atrial Flutter

     Carlo Raj, MD

    Carlo Raj, MD

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