Tachycardia: Atrial Fibrillation: Pathogenesis

by Carlo Raj, MD

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    00:01 Continue our discussion of dysrhythmia and conduction system diseases.

    00:06 Remember once again with arrhythmias, we'll do two different categories or two major etiologic backgrounds.

    00:14 One would be conduction system issues, the other one was vascular.

    00:18 So for under conduction disease, we have looked at bradyarrhythmias.

    00:23 Our topic now will take us into tachyarrhythmias.

    00:27 And with tachyarrhythmias, we will focus upon SVT's at first, supraventricular tachycardias above the ventricles.

    00:35 And we will then divide this into part one and part two.

    00:38 In part one, we'll take a look at atrial fibrillation and atrial flutter.

    00:42 Let's begin.

    00:44 Now with AFib, exceedingly common rhythm especially in elder patients.

    00:51 So as we get older - well, a number of things start slowing down.

    00:55 In this case, things start speeding up.

    00:58 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.

    01:08 You end up developing or end up accumulating more creatinine.

    01:11 As we get older, our ability to protect our cell membrane from free radicals starts diminishing.

    01:17 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's not as efficient and effective as it once was.

    01:34 And so in elderly people, well, there's every possibility that atrial fibrillation might be taking place.

    01:40 And anytime there's an AFib, what are you worried about? Well, you're worried about that increased turbulence within the atrium and so therefore may result in stasis.

    01:51 And with that stasis, you're worried about Virchow's triad.

    01:56 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 sequelae of your clot formation and the embolization of the thrombus moving forward through the left atrium specifically.

    02:15 Which one are you worried about the most? Through the carotid artery and you're worried about a cerebral vascular accident such as a stroke.

    02:23 Now keep in mind that you could have an embolization and might end up in the SMA; superior mesenteric artery, resulting in ischemic and bowel disease that is also an emergency.

    02:35 Isn't it? Or it may result in renal artery resulting in renal artery stenosis.

    02:40 All that you're doing is following the pathway of a clot or thrombus from the left atrium and distally into whatever organ system.

    02:50 So what do you wanna 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: Basic Principles with Carlo Raj.

    Included Quiz Questions

    1. The risk of stroke is not increased in patients with asymptomatic atrial fibrillation.
    2. 15-20% of strokes are due to atrial blood clot embolism as a result of atrial fibrillation.
    3. Stroke is the most devastating complication of atrial fibrillation.
    4. Atrial fibrillation increases the risk for stroke by 4 -5 fold.
    5. Atrial fibrillation is due to disorganized electrical activity in the atrium.

    Author of lecture Tachycardia: Atrial Fibrillation: Pathogenesis

     Carlo Raj, MD

    Carlo Raj, MD

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    muchas gracias
    By Fernanda A. on 11. September 2018 for Tachycardia: Atrial Fibrillation: Pathogenesis

    Explica exactamente lo que es, me ha ayudado mucho para dar un exposicion del tema