Afib

Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor
blood flow to the body.
During atrial fibrillation, the heart's two upper chambers (the atria) beat chaotically
and irregularly out of coordination with the two lower chambers (the ventricles) of
the heart. Atrial fibrillation symptoms often include heart palpitations, shortness of
breath and weakness.
Episodes of atrial fibrillation can come and go, or you may develop atrial fibrillation
that doesn't go away and may require treatment. Although atrial fibrillation itself
usually isn't life-threatening, it is a serious medical condition that sometimes requires
emergency treatment. It can lead to complications. Atrial fibrillation may lead to
blood clots forming in the heart that may circulate to other organs and lead to
blocked blood flow (ischemia).
Treatments for atrial fibrillation may include medications and other interventions to
try to alter the heart's electrical system.

Symptoms
A heart in atrial fibrillation doesn't beat efficiently. It may not be able to pump enough
blood out to your body with each heartbeat.
Some people with atrial fibrillation have no symptoms and are unaware of their
condition until it's discovered during a physical examination. Those who do have
atrial fibrillation symptoms may experience signs and symptoms such as:

Palpitations, which are sensations of a racing, uncomfortable, irregular heartbeat or a flipflopping in your chest

Weakness
Reduced ability to exercise
Fatigue
Lightheadedness
Dizziness
Confusion
Shortness of breath
Chest pain

Atrial fibrillation may be:

Occasional. In this case it's called paroxysmal (par-ok-SIZ-mul) atrial fibrillation. You may
have symptoms that come and go, lasting for a few minutes to hours and then stopping on
their own.

Persistent. With this type of atrial fibrillation, your heart rhythm doesn't go back to normal on
its own. If you have persistent atrial fibrillation, you'll need treatment such as an electrical
shock or medications in order to restore your heart rhythm.
Permanent. In this type of atrial fibrillation, the abnormal heart rhythm can't be restored.
You'll have atrial fibrillation permanently, and you'll often require medications to control your
heart rate. Most people with permanent atrial fibrillation will require blood thinners to prevent
blood clots.

Causes
Atrial fibrillation is an irregular and often rapid heart rate that occurs when the two
upper chambers of your heart (atria) experience chaotic electrical signals.
Your heart consists of four chambers two upper chambers (atria) and two lower
chambers (ventricles). Within the upper right chamber of your heart (right atrium) is a
group of cells called the sinus node. This is your heart's natural pacemaker. The sinus
node produces the impulse that normally starts each heartbeat.
Normally, the impulse travels first through the atria and then through a connecting
pathway between the upper and lower chambers of your heart called the
atrioventricular (AV) node. As the signal passes from the sinus node through the atria,
they contract, pumping blood from your atria into the ventricles below. As the signal
passes through the AV node to the ventricles, it signals the ventricles to contract,
pumping blood out to your body.
In atrial fibrillation, the upper chambers of your heart (atria) experience chaotic
electrical signals. As a result, they quiver. The AV node the electrical connection
between the atria and the ventricles is bombarded with impulses trying to get
through to the ventricles. The ventricles also beat rapidly, but not as rapidly as the
atria, as not all the impulses get through. The reason is that the AV node is like a
highway on-ramp only so many vehicles can get on at one time.
The result is a fast and irregular heart rhythm. The heart rate in atrial fibrillation may
range from 100 to 175 beats a minute. The normal range for a heart rate is 60 to 100
beats a minute.

Possible causes of atrial fibrillation

Abnormalities or damage to the heart's structure are the most common cause of atrial
fibrillation. Possible causes of atrial fibrillation include:

High blood pressure

Heart attacks
Coronary artery disease
Abnormal heart valves
Heart defects you're born with (congenital)
An overactive thyroid gland or other metabolic imbalance
Exposure to stimulants, such as medications, caffeine or tobacco, or to alcohol
Sick sinus syndrome improper functioning of the heart's natural pacemaker
Lung diseases
Previous heart surgery
Viral infections
Stress due to pneumonia, surgery or other illnesses
Sleep apnea

However, some people who have atrial fibrillation don't have any heart defects or
damage, a condition called lone atrial fibrillation. In lone atrial fibrillation, the cause
is often unclear, and serious complications are rare.

Atrial flutter
Atrial flutter is similar to atrial fibrillation, but the rhythm in your atria is more
organized and less chaotic than the abnormal patterns common with atrial fibrillation.
Sometimes you may have atrial flutter that develops into atrial fibrillation and vice
versa.
The risk factors for and the symptoms and causes of atrial flutter are similar to those
of atrial fibrillation. For example, strokes are also a concern in someone with atrial
flutter. As with atrial fibrillation, atrial flutter is usually not life-threatening when it's
properly treated.

The nurse is caring for a client with cardiac disease who

has been placed on a cardiac monitor. The nurse notes that
the client has developed atrial fibrillation and has a
ventricular rate of 150 beats/min. The nurse should next
assess the client for which finding?
1.Hypotension
2.Flat neck veins
3.Complaints of nausea
4.Complaints of headache
The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/min is

at risk for low cardiac output owing to loss of atrial kick. The nurse assesses the client for
palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness,
syncope, shortness of breath, and distended neck veins.

A client has developed uncontrolled atrial fibrillation

with a ventricular rate of 150 beats/min. What
manifestation should the nurse observe for when performing
the client's focused assessment?
1.Flat neck veins
2.Nausea and vomiting
3.Hypotension and dizziness
4.Clubbed fingertips and headache
The client with uncontrolled atrial fibrillation with a ventricular rate greater than 100 beats/min is
at risk for low cardiac output due to loss of atrial kick. The nurse assesses the client for
palpitations, chest pain or discomfort, hypotension, pulse deficit, fatigue, weakness, dizziness,
syncope, shortness of breath, and distended neck veins.

The nurse notes that a client's cardiac rhythm shows

absent P waves and no PR interval. How should the nurse
interpret this rhythm?
1.Bradycardia
2.Tachycardia
3.Atrial fibrillation
4.Normal sinus rhythm (NSR)
In atrial fibrillation, the P waves may be absent. There is no PR interval, and the QRS duration
usually is normal and constant. Bradycardia is a slowed heart rate, and tachycardia is a fast heart
rate. In NSR a P wave precedes each QRS complex, the rhythm is essentially regular, the PR
interval is 0.12 to 0.20 seconds in duration, and the QRS interval is 0.06 to 0.10 seconds in
duration.
The nurse coming on duty receives the report from the nurse going off duty. Which of the
following clients should the on-duty nurse assess first?
A 76-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and is
receiving IV diltiazem (Cardizem).
The client with A-fib has the greatest potential to become unstable and is on IV medication that
requires close monitoring. After assessing this client, the nurse should assess the client with
thrombophlebitis who is receiving a heparin infusion, and then go to the 58-year-old client
admitted 2-days ago with heart failure (her s/s are resolving and dont require immediate
attention). The lowest priority is the 89-year-old with end stage right-sided heart failure, who
requires time consuming supportive measures.
A client has frequent bursts of ventricular tachycardia on the cardiac monitor. A nurse is most
concerned with this dysrhythmia because:
It can develop into ventricular fibrillation at any time.

Ventricular tachycardia is a life-threatening dysrhythmia that results from an irritable ectopic focus
that takes over as the pacemaker for the heart. The low cardiac output that results can lead quickly
to cerebral and myocardial ischemia. Clients frequently experience a feeling of impending
death. Ventricular tachycardia is treated with antiarrhythmic medications or magnesium sulfate,
cardioversion (client awake), or defibrillation (loss of consciousness), Ventricular tachycardia can
deteriorate into ventricular fibrillation at any time.
Which medication is indicated for the patient with atrial fibrillation who is at high risk for stroke?

Coumadin
The risk is even higher if other heart disease is present along with atrial fibrillation. Your doctor
may prescribe blood-thinning medications (anticoagulants) such
as: Warfarin (Coumadin). Warfarin may be prescribed to prevent blood clots.

.
Electrocardiogram (ECG) characteristics of atrial fibrillation include which of the following?

Atrial rate of 300 to 400