Continue our discussion of dysrhythmia and conduction system diseases.
Remember once again with arrhythmias,
we'll do two different categories or two major etiologic backgrounds.
One would be conduction system issues, the other one was vascular.
So for under conduction disease, we have looked at bradyarrhythmias.
Our topic now will take us into tachyarrhythmias.
And with tachyarrhythmias, we will focus upon SVT's
at first, supraventricular tachycardias above the ventricles.
And we will then divide this into part one and part two.
In part one, we'll take a look at atrial fibrillation and atrial flutter.
Now with AFib, exceedingly common rhythm especially in elder patients.
So as we get older - well, 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.
You end up developing or end up accumulating more creatinine.
As we get older, our ability to protect our cell membrane from free radicals 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's not as efficient and effective as it once was.
And so in elderly people, well, there's every possibility that atrial fibrillation might be taking place.
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.
And with that stasis, you're 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.
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.
Which one are you worried about the most?
Through the carotid artery and you're worried about a febrile vascular accident such as a stroke.
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.
Isn't it? Or it may result in renal artery resulting in renal artery stenosis.
All that you're doing is following the pathway of a clot or thrombus from the left atrium
and distally into whatever organ system.
So what do you wanna give to this patient prophylactically?
A blood thinner such as warfarin.