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.
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.
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.
In current practice, new oral anticoagulants (or NOACs) are prescribed over warfarin.
However, there are exceptions, such as intolerance, increased cost, or some cases of chronic kidney disease where warfarin is preferable.