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Tachycardia: Atrial Fibrillation: Pathogenesis

by Carlo Raj, MD
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    00:01 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.

    00:15 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.

    00:43 Let us begin. Now, with afib exceedingly common rhythm especially in elder patients.

    00:52 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 you are truly worried about.

    02:05 With that clot formation, of all the sequalae of your clot formation, and the embolization of the thrombus moving forward through the left atrium specifically, which one you are worried about the most? Through the carotid artery and you are worried about the cerebrovascular accident such as a stroke. Now keep in mind that you could have an embolization. It might end up in the SMA, superior mesenteric artery resulting in ischemic bowel disease. That is also an emergency, isn't it? Or it may result in renal artery resulting in renal artery stenosis. All that you are doing is following the pathway of a clot or a thrombus from the left atrium and distally into whatever organ system. So what do you want to give to this patient prophylactically? A blood thinner such as warfarin.


    About the Lecture

    The lecture Tachycardia: Atrial Fibrillation: Pathogenesis by Carlo Raj, MD is from the course Arrhythmias.


    Author of lecture Tachycardia: Atrial Fibrillation: Pathogenesis

     Carlo Raj, MD

    Carlo Raj, MD


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