Tachycardia: Atrial Fibrillation: Diagnosis

00:00 Atrial fib, the ECG, irregularly irregular conduction of the ventricles. Not regularly, but irregularly irregular. So, a complete discorrelation or lack of proper organization of EKG beginning with what wave? The P wave. The P wave is completely fibrillated.

00:20 What does that mean? Wave-like pattern. Very obscure, difficult to identify and so, therefore, you don't have proper conduction through the heart. Thyroid function absolutely tested as being one of the differentials, hyperthryoidism may result in atrial fibrillation. Now what you are seeing here is exactly that. Can you find properly a P wave here? On this 12-lead ECG, I do not want you to focus upon what you see V1 where it may then appear as being sawtooth and you chose atrial flutter. Don't do that. If you find majority of your leads here showing you fibrillation as you are seeing and you find an irregular pattern, take a look at the bottom strip here for me. That P wave is in complete chaos. No organization at all.

01:12 And the QRS complex not correlated at all with the P wave. How could it? 300 beats per minute perhaps, really fast and. In addition, take a look at when the QRS complex are showing up. Are they showing up regularly? Irregularly irregular atrial fibrillation. Once again what are you worried about? Clot formation. What are you worried about in terms of your clot formation? Your thrombi embolizing into the carotid artery may result in a stroke.

01:41 In current practice, new oral anticoagulants (or NOACs) are prescribed over warfarin.

01:49 However, there are exceptions, such as intolerance, increased cost, or some cases of chronic kidney disease where warfarin is preferable.